期刊
VASCULAR MEDICINE
卷 26, 期 6, 页码 641-647出版社
SAGE PUBLICATIONS LTD
DOI: 10.1177/1358863X211023559
关键词
economic analysis; inferior vena cava (IVC) filters; pulmonary embolism (PE); thrombosis
资金
- Trauma Research Program from the Royal Perth Hospital Medical Research Foundation
- Translational Research Project from the Western Australian Department of Health
- Clinician Research Fellowship (round 3) from the Raine Medical Research Foundation
The study found that the cost-effectiveness of using vena cava filters to prevent pulmonary embolism depends on the duration of contraindications to prophylactic anticoagulation for trauma patients.
Introduction: Vena cava filters have been used as a primary means to prevent symptomatic pulmonary embolism (PE) in trauma patients who cannot be anticoagulated after severe injury, but the economic implications for this practice remain unclear. Methods: Using a healthcare system perspective to analyze the a priori primary outcome of the da Vinci trial, we report the cost-effectiveness of using vena cava filters as a primary means to prevent PE in patients who have contraindications to prophylactic anticoagulation after major trauma. Results: Of the 240 patients enrolled, complete, prospectively collected, hospital cost data during the entire hospital stay - including costs for the filter, medical/nursing/allied health staff, medical supplies, pathology tests, and radiological imaging - were available in 223 patients (93%). Patients allocated to the filter group (n = 114) were associated with a reduced risk of PE (0.9%) compared to those in the control group (n = 109, 5.5%; p = 0.048); and the filter's benefit was more pronounced among those who could not be anticoagulated within 7 days (filter: 0% vs control: 16%, Bonferroni-corrected p = 0.02). Overall, the cost needed to prevent one PE was high (AUD $379,760), but among those who could not be anticoagulated within 7 days, the costs to prevent one PE (AUD $36,156; similar to USD $26,032) and gain one quality-adjusted life-year (AUD $30,903; similar to USD $22,250) were substantially lower. Conclusion: The cost of using a vena cava filter to prevent PE for those who have contraindications to prophylactic anticoagulation within 3 days of injury is prohibitive, unless such contraindications remain for longer than 7 days.
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