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Flap complications and thrombophilia: an evidence-based model and cost analysis for preoperative screening.

Bowman KG, Carty MJ - Eplasty (2011)

Bottom Line: We performed a break-even and incremental cost-effective ratio analysis for several screening and intervention scenarios.Our thrombotic free flap complication rate is 4.9%.Incremental cost-effective ratio analyses estimate a cost per avoided flap complication of $33 638 for a full panel scenario, $15 617 for a limited panel scenario and $25 455 for an all therapy scenario.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Preoperative screening for thrombophilias in free flap candidates may be cost-effective.

Methods: We developed a model for thrombogenic flap complications using reported thrombophilia prevalences and thromboembolic risk ratios, as well as free flap complication rates from our institution. We performed a break-even and incremental cost-effective ratio analysis for several screening and intervention scenarios.

Results: Our thrombotic free flap complication rate is 4.9%. A full thrombophilia screen breaks even when the cost of complication exceeds $57 000 per patient; a limited screen breaks even at $39 000, and a scenario in which all patients undergo chemoprophylaxis breaks even at $49 000. Incremental cost-effective ratio analyses estimate a cost per avoided flap complication of $33 638 for a full panel scenario, $15 617 for a limited panel scenario and $25 455 for an all therapy scenario.

Conclusions: Our analyses show that preoperative thrombophilia screening may be a cost-effective measure for the prevention of free flap thrombotic complications.

No MeSH data available.


Related in: MedlinePlus

Break-even analysis demonstrates the break-even points for the 3 intervention scenarios compared to baseline.
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Figure 1: Break-even analysis demonstrates the break-even points for the 3 intervention scenarios compared to baseline.

Mentions: Break-even analyses demonstrated that a complete preoperative thrombophilia screen (Full Panel Scenario) breaks even when the cost of thrombotic flap complication exceeds $57 000 per patient. A limited thrombophilia screen that captures 87% of anticipated thrombotic complications at a substantially reduced panel cost (Limited Panel Scenario) breaks even when the cost of thrombotic flap complication exceeds $39 000 per patient. Finally, prophylactic treatment of all patients with 1 month of enoxaparin therapy in the absence of any preoperative screening (All Therapy Scenario) breaks even when the cost of thrombotic flap complication exceeds $49 000 per patient (Table 5, Fig 1).


Flap complications and thrombophilia: an evidence-based model and cost analysis for preoperative screening.

Bowman KG, Carty MJ - Eplasty (2011)

Break-even analysis demonstrates the break-even points for the 3 intervention scenarios compared to baseline.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3140287&req=5

Figure 1: Break-even analysis demonstrates the break-even points for the 3 intervention scenarios compared to baseline.
Mentions: Break-even analyses demonstrated that a complete preoperative thrombophilia screen (Full Panel Scenario) breaks even when the cost of thrombotic flap complication exceeds $57 000 per patient. A limited thrombophilia screen that captures 87% of anticipated thrombotic complications at a substantially reduced panel cost (Limited Panel Scenario) breaks even when the cost of thrombotic flap complication exceeds $39 000 per patient. Finally, prophylactic treatment of all patients with 1 month of enoxaparin therapy in the absence of any preoperative screening (All Therapy Scenario) breaks even when the cost of thrombotic flap complication exceeds $49 000 per patient (Table 5, Fig 1).

Bottom Line: We performed a break-even and incremental cost-effective ratio analysis for several screening and intervention scenarios.Our thrombotic free flap complication rate is 4.9%.Incremental cost-effective ratio analyses estimate a cost per avoided flap complication of $33 638 for a full panel scenario, $15 617 for a limited panel scenario and $25 455 for an all therapy scenario.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Preoperative screening for thrombophilias in free flap candidates may be cost-effective.

Methods: We developed a model for thrombogenic flap complications using reported thrombophilia prevalences and thromboembolic risk ratios, as well as free flap complication rates from our institution. We performed a break-even and incremental cost-effective ratio analysis for several screening and intervention scenarios.

Results: Our thrombotic free flap complication rate is 4.9%. A full thrombophilia screen breaks even when the cost of complication exceeds $57 000 per patient; a limited screen breaks even at $39 000, and a scenario in which all patients undergo chemoprophylaxis breaks even at $49 000. Incremental cost-effective ratio analyses estimate a cost per avoided flap complication of $33 638 for a full panel scenario, $15 617 for a limited panel scenario and $25 455 for an all therapy scenario.

Conclusions: Our analyses show that preoperative thrombophilia screening may be a cost-effective measure for the prevention of free flap thrombotic complications.

No MeSH data available.


Related in: MedlinePlus