Sarasin F P, Bounameaux H
Department of Internal Medicine, Hôpital Cantonal Universitaire, Geneva, Switzerland.
Arch Surg. 1996 Jul;131(7):694-7; discussion 698. doi: 10.1001/archsurg.1996.01430190016003.
To evaluate the net clinical benefit and the economic burden of prophylactic anticoagulation prolonged after hospital discharge following general surgery.
A cost-effective analysis representing the risks of developing symptomatic venous thromboembolism beyond the hospital stay, the risks of major bleeding, and the efficacy of treatment. Data were drawn from the literature.
A hypothetical cohort of 10,000 patients discharged from the hospital after general surgery (gastrointestinal, gynecologic, urologic, or vascular surgery).
We compared 2 strategies: (1) prolonged self-administered prophylactic low-dose low-molecular-weight heparin during 4 weeks after discharge from the hospital and (2) anticoagulant therapy with heparin started immediately after the first clinically overt venous thromboembolism.
The number of venous thromboembolisms prevented, the number of major bleeding events induced, and the average direct costs.
Prophylactic low-molecular-weight heparin was an effective therapy. Depending on the rate of venous thromboembolism (0.06% to 0.18% per week), this strategy prevented 19 to 58 venous thromboembolisms for a cohort of 10,000 patients treated, more than the number of anticoagulation-related complications (n = 10). Its marginal costs, however, exceeded $2.5 million (US dollars) for 10,000 patients. As the weekly rate of venous thromboembolism increased, prophylactic low-molecular-weight heparin became more cost-effective, with a marginal cost-effectiveness ratio per venous thromboembolism prevented ranging from $135,903 (rate of venous thromboembolism, 0.06% per week) to 45,353 (rate of venous thromboembolism, 0.18% per week).
Although prolonged prophylactic anticoagulation after hospital discharge for general surgery is effective in preventing venous thromboembolism, we believe that its marginal costs are too high to recommend its indiscriminate use.
评估普通外科手术后出院后延长预防性抗凝治疗的净临床效益和经济负担。
一项成本效益分析，反映出院后发生症状性静脉血栓栓塞的风险、大出血风险和治疗效果。数据来源于文献。
一个假设的队列，包含10000例普通外科（胃肠、妇科、泌尿外科或血管外科）手术后出院的患者。
我们比较了两种策略：（1）出院后4周内延长自我给药的预防性低剂量低分子量肝素；（2）首次临床明显静脉血栓栓塞后立即开始用肝素进行抗凝治疗。
预防的静脉血栓栓塞数量、诱发的大出血事件数量和平均直接成本。
预防性低分子量肝素是一种有效的治疗方法。根据静脉血栓栓塞发生率（每周0.06%至0.18%），该策略为10000例接受治疗的患者预防了19至58例静脉血栓栓塞，超过了抗凝相关并发症的数量（n = 10）。然而，对于10000例患者，其边际成本超过250万美元（美元）。随着静脉血栓栓塞每周发生率的增加，预防性低分子量肝素变得更具成本效益，每预防一例静脉血栓栓塞的边际成本效益比从135903美元（静脉血栓栓塞发生率，每周0.06%）到45353美元（静脉血栓栓塞发生率，每周0.18%）不等。
尽管普通外科手术后出院后延长预防性抗凝治疗在预防静脉血栓栓塞方面有效，但我们认为其边际成本过高，不建议不加区分地使用。
