在患有假心的患者中,用于非心脏手术的抗凝药. 低风险是否意味着高成本?
M H Eckman1, J R Beshansky, I Durand-Zaleski
1Department of Medicine, New England Medical Center, Boston, MA 02111.
JAMA
|March 16, 1990
概括
在非心脏手术的假心患者中,为治疗氨酸而延长住院治疗往往不具有成本效益. 预防罕见的血栓塞栓事件的高成本超过了益处,除了高风险的门.
科学领域:
- 心血管外科心血管外科
- 卫生经济学 卫生经济学
- 药物经济学 药物经济学
背景情况:
- 患有假心的患者需要在非心脏手术期间进行抗凝管理.
- 静脉注射肝素通常用于预防血栓塞栓症,当口服抗凝剂中断时.
- 这种做法可能会导致长时间的住院和大量的费用.
研究的目的:
- 为了评估长时间住院治疗静脉注射肝素治疗非心脏手术的假心患者的成本效益.
- 为了确定每获得的质量调整生命年 (QALY) 的边际成本,避免了血栓塞栓事件,避免了死亡.
- 评估当前抗凝血桥梁策略的经济影响.
主要方法:
- 进行了成本效益分析.
- 每个获得的QALY计算的边际成本.
- 每个避免的血栓栓塞事件的计算边际成本.
- 计算每次避免死亡的边际成本.
主要成果:
- 对于大多数人造心脏门来说,延长医院住院治疗肝素的边际成本是过高的.
- 与当代疗法相比,成本效益是不利的.
- 对于患有最多血栓形成的人造心脏门的患者,存在例外.
结论:
- 在非心脏手术的假心患者中,常规的长时间住院治疗肝素桥梁通常是不具有成本效益的.
- 临床决策应考虑膜血栓发生率和个体患者的风险.
- 将成本效益数据纳入实践的伦理和法律考虑需要讨论.
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