Limits...
Impact of thromboprophylaxis across the US acute care setting.

Huang W, Anderson FA, Rushton-Smith SK, Cohen AT - PLoS ONE (2015)

Bottom Line: In this retrospective database cost-effectiveness evaluation, a decision-tree model was developed to estimate deaths within 30 days of admission and outcomes attributable to VTE that might have been averted by use of low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH).The cost-effectiveness analysis indicated that VTE-prevention strategies would reduce deaths by 0.5% and 0.3%, comparing LMWH and UFH strategies with no prophylaxis, translating into savings of $50,637 and $25,714, respectively, per death averted.By extrapolating these findings to the NIS and applying cost-effectives analysis results, the full implementation of ACCP guidelines would reduce number of deaths (by 15,875 if using LMWH or 10,201 if using UFH), and was extrapolated to calculate the cost reduction of $803M for LMWH and $262M for UFH.

View Article: PubMed Central - PubMed

Affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.

ABSTRACT

Background: The risk of venous thromboembolism (VTE) can be reduced by appropriate use of anticoagulant prophylaxis. VTE prophylaxis does, however, remain substantially underused, particularly among acutely ill medical inpatients. We sought to evaluate the clinical and economic impact of increasing use of American College of Chest Physicians (ACCP)-recommended VTE prophylaxis among medical inpatients from a US healthcare system perspective.

Methods and findings: In this retrospective database cost-effectiveness evaluation, a decision-tree model was developed to estimate deaths within 30 days of admission and outcomes attributable to VTE that might have been averted by use of low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). Incremental cost-effectiveness ratio was calculated using "no prophylaxis" as the comparator. Data from the ENDORSE US medical inpatients and the US nationwide Inpatient Sample (NIS) were used to estimate the annual number of eligible inpatients who failed to receive ACCP-recommended VTE prophylaxis. The cost-effectiveness analysis indicated that VTE-prevention strategies would reduce deaths by 0.5% and 0.3%, comparing LMWH and UFH strategies with no prophylaxis, translating into savings of $50,637 and $25,714, respectively, per death averted. The ENDORSE findings indicated that 51.1% of US medical inpatients were at ACCP-defined VTE risk, 47.5% of whom received ACCP-recommended prophylaxis. By extrapolating these findings to the NIS and applying cost-effectives analysis results, the full implementation of ACCP guidelines would reduce number of deaths (by 15,875 if using LMWH or 10,201 if using UFH), and was extrapolated to calculate the cost reduction of $803M for LMWH and $262M for UFH.

Conclusions: Efforts to improve VTE prophylaxis use in acutely ill inpatients are warranted due to the potential for reducing VTE-attributable deaths, with net cost savings to healthcare systems.

No MeSH data available.


Related in: MedlinePlus

Cost-effectiveness acceptability curve based on a Monte Carlo simulation (10,000 iterations).bid, twice daily; IU, international units; qd, daily; VTE, venous thromboembolism.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4376674&req=5

pone.0121429.g003: Cost-effectiveness acceptability curve based on a Monte Carlo simulation (10,000 iterations).bid, twice daily; IU, international units; qd, daily; VTE, venous thromboembolism.

Mentions: One-way sensitivity analyses of key estimates in our decision-tree model indicated that as long as the probability of developing PE after DVT without treatment is above 14%, both prophylaxis strategies are cost-effective compared with no prophylaxis (Fig. 2A). Second, the probability of death among PE patients who survived from the critical period immediately after the acute event increased from 0% to 26% (point-estimate in the decision-tree model); the overall reduction in death rates ranged from 0.1% to 0.5% for the LMWH strategy, and from 0% to 0.3% for the UFH strategy, compared with no prophylaxis (Fig. 2B). Third, the LMWH strategy is always dominant (Fig. 2A, B), regardless of the exact value of the two estimates. The Monte Carlo simulation with 10,000 iterations indicated that: (1) regardless of the cost per death averted, over 50% of iterations indicated that the LMWH strategy is cost-effective; (2) if the healthcare system is willing to pay approximately $5,000 per death averted, the UFH strategy starts to have higher probability of being cost-effective compared with no prophylaxis (Fig. 3).


Impact of thromboprophylaxis across the US acute care setting.

Huang W, Anderson FA, Rushton-Smith SK, Cohen AT - PLoS ONE (2015)

Cost-effectiveness acceptability curve based on a Monte Carlo simulation (10,000 iterations).bid, twice daily; IU, international units; qd, daily; VTE, venous thromboembolism.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4376674&req=5

pone.0121429.g003: Cost-effectiveness acceptability curve based on a Monte Carlo simulation (10,000 iterations).bid, twice daily; IU, international units; qd, daily; VTE, venous thromboembolism.
Mentions: One-way sensitivity analyses of key estimates in our decision-tree model indicated that as long as the probability of developing PE after DVT without treatment is above 14%, both prophylaxis strategies are cost-effective compared with no prophylaxis (Fig. 2A). Second, the probability of death among PE patients who survived from the critical period immediately after the acute event increased from 0% to 26% (point-estimate in the decision-tree model); the overall reduction in death rates ranged from 0.1% to 0.5% for the LMWH strategy, and from 0% to 0.3% for the UFH strategy, compared with no prophylaxis (Fig. 2B). Third, the LMWH strategy is always dominant (Fig. 2A, B), regardless of the exact value of the two estimates. The Monte Carlo simulation with 10,000 iterations indicated that: (1) regardless of the cost per death averted, over 50% of iterations indicated that the LMWH strategy is cost-effective; (2) if the healthcare system is willing to pay approximately $5,000 per death averted, the UFH strategy starts to have higher probability of being cost-effective compared with no prophylaxis (Fig. 3).

Bottom Line: In this retrospective database cost-effectiveness evaluation, a decision-tree model was developed to estimate deaths within 30 days of admission and outcomes attributable to VTE that might have been averted by use of low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH).The cost-effectiveness analysis indicated that VTE-prevention strategies would reduce deaths by 0.5% and 0.3%, comparing LMWH and UFH strategies with no prophylaxis, translating into savings of $50,637 and $25,714, respectively, per death averted.By extrapolating these findings to the NIS and applying cost-effectives analysis results, the full implementation of ACCP guidelines would reduce number of deaths (by 15,875 if using LMWH or 10,201 if using UFH), and was extrapolated to calculate the cost reduction of $803M for LMWH and $262M for UFH.

View Article: PubMed Central - PubMed

Affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.

ABSTRACT

Background: The risk of venous thromboembolism (VTE) can be reduced by appropriate use of anticoagulant prophylaxis. VTE prophylaxis does, however, remain substantially underused, particularly among acutely ill medical inpatients. We sought to evaluate the clinical and economic impact of increasing use of American College of Chest Physicians (ACCP)-recommended VTE prophylaxis among medical inpatients from a US healthcare system perspective.

Methods and findings: In this retrospective database cost-effectiveness evaluation, a decision-tree model was developed to estimate deaths within 30 days of admission and outcomes attributable to VTE that might have been averted by use of low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). Incremental cost-effectiveness ratio was calculated using "no prophylaxis" as the comparator. Data from the ENDORSE US medical inpatients and the US nationwide Inpatient Sample (NIS) were used to estimate the annual number of eligible inpatients who failed to receive ACCP-recommended VTE prophylaxis. The cost-effectiveness analysis indicated that VTE-prevention strategies would reduce deaths by 0.5% and 0.3%, comparing LMWH and UFH strategies with no prophylaxis, translating into savings of $50,637 and $25,714, respectively, per death averted. The ENDORSE findings indicated that 51.1% of US medical inpatients were at ACCP-defined VTE risk, 47.5% of whom received ACCP-recommended prophylaxis. By extrapolating these findings to the NIS and applying cost-effectives analysis results, the full implementation of ACCP guidelines would reduce number of deaths (by 15,875 if using LMWH or 10,201 if using UFH), and was extrapolated to calculate the cost reduction of $803M for LMWH and $262M for UFH.

Conclusions: Efforts to improve VTE prophylaxis use in acutely ill inpatients are warranted due to the potential for reducing VTE-attributable deaths, with net cost savings to healthcare systems.

No MeSH data available.


Related in: MedlinePlus