Yazarlar : Sud S, Mittmann N, Cook DJ, Geerts W, Chan B, Dodek P, Gould MK, Guyatt G, Arabi Y, Fowler RA; On Behalf of the E-PROTECT Investigators and the Canadian Critical Care Trials Group.

Yayın : Am J Respir Crit Care Med.

Yayın Yılı : 2011

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/21868500

Konu : Tromboz

Literatür İçeriği :  

Abstract

OBJECTIVE:

To evaluate the cost-effectiveness of strategies to reduce morbidity from venous thromboembolism in critically ill patients.

METHODS:

A Markov decision analytic model to compare weekly compression ultrasound screening (screening) plus investigation for clinically suspected DVT (case finding) versus case finding alone; and, a hypothetical program to increase adherence to DVT prevention. Probabilities were derived from a systematic review of VTE in medical-surgical ICU patients. Costs (in 2010 USD) were obtained from hospitals in Canada, Australia, the United States and the medical literature. Analyses were conducted from a societal perspective over a lifetime horizon. Outcomes included costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios.

MEASUREMENTS AND MAIN RESULTS:

In the base case, the rate of proximal DVT was 85 per 1000 patients. Screening resulted in 3 fewer pulmonary emboli (PE) than case-finding alone but also 2 additional bleeding episodes, and cost $223,801 per QALY gained. In sensitivity analyses, screening cost less than $50,000 per QALY only if the probability of proximal DVT increased from a baseline of 8.5% to 16%. By comparison, increasing adherence to appropriate pharmacological thromboprophylaxis by 10%, resulted in 16 fewer DVT, 1 fewer PE, 1 additional heparin-induced thrombocytopenia and bleeding event, and cost $27,953 per QALY gained. Programs achieving increased adherence to best-practice VTE prevention were cost-effective over a wide range of program costs and were robust in probabilistic sensitivity analyses.

CONCLUSION:

Appropriate prophylaxis provides better value in terms of costs and health gains than routine screening for DVT. Resources should be targeted at optimizing thromboprophylaxis.

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