预防术后血栓栓塞的成本效益。

D Bergqvist, T Mätzsch, S Jendteg, B Lindgren, U Persson
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引用次数: 0

摘要

近年来,医疗保健的物有所值已成为人们日益关注的问题。进行经济评估有多种方法,最简单的是成本效益分析,其中成本的差异将影响方法之间的选择。成本效用和成本效益分析是经济评价的更高级形式。在本成本-效果分析中,对以下三种旨在解决术后血栓栓塞并发症的策略进行了比较:(a)不进行预防,但对发生的并发症进行治疗;(b)对40岁以上的患者进行低剂量肝素的一般预防;(c)基于术后纤维蛋白原摄取试验监测的选择性治疗。此外,这些选择评估了三种类型的手术:一般腹部手术,胆囊切除术和选择性髋关节手术。血栓栓塞和出血性并发症的费用是根据Malmö住院患者的现有数据估计的。对血栓形成频率、预防效果和治疗费用进行敏感性分析。在髋关节和普通外科手术中,一般预防可以最大限度地降低医疗保健费用,而在胆囊切除术患者(即血栓形成频率低于8%)中,不进行预防是最具成本效益的替代方案。一般预防可最大限度地减少患者因血栓栓塞性疾病以及择期髋关节手术造成的健康损失的持续时间。胆囊切除术后,个人健康损失在不预防和一般预防之间没有差异。在所有类别中,选择性治疗总是最不令人满意的选择,而且总是最昂贵的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The cost-effectiveness of prevention of post-operative thromboembolism.

In recent years, value for money in health care has become of increasing concern. There are various ways to perform an economic evaluation, the most simple being a cost-effectiveness analysis, where differences in costs will influence the choice between methods. Cost-utility and cost-benefit analyses represent more advanced forms of economic evaluations. In this cost-effectiveness analysis, the following three strategies aimed at solving the problem of post-operative thromboembolic complications were compared: (a) no prophylaxis but treatment of occurring complications, (b) general prophylaxis with low-dose heparin for patients over 40 years of age and (c) selective treatment based on post-operative surveillance with a fibrinogen uptake test. Moreover, these alternatives were evaluated for three types of surgery: general abdominal surgery, cholecystectomy and elective hip surgery. Costs for thromboembolic and haemorrhagic complications were estimated from data available for patients hospitalized in Malmö. A sensitivity analysis was made with regard to the frequency of thrombosis, prophylactic effect and treatment costs. Health care costs would be minimized with general prophylaxis in hip and general surgery, whereas no prophylaxis is the most cost-effective alternative in cholecystectomy patients, i.e. with a frequency of thrombosis below 8%. General prophylaxis minimized the duration of patients' health losses due to thromboembolic disease in general, as well as in elective hip surgery. After cholecystectomy, no difference in health loss for the individual was found between the alternative of no prophylaxis and general prophylaxis. Selective treatment was always the least satisfactory alternative in all categories and always the most expensive.

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