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医疗住院患者的药理性血栓预防的有效性和成本效益:决策分析建模研究研究
Sarah Davis1, Steve Goodacre1, Daniel Horner1,2,3
1Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
BMJ medicine
|February 23, 2024
概括
为所有医疗住院患者提供药理性血栓预防是最具成本效益的策略. 风险评估模型只有在具有非常高的灵敏度的情况下才具有成本效益,几乎可以识别所有高风险患者进行治疗.
科学领域:
- 卫生经济学 卫生经济学
- 临床决策 临床决策
- 药理学 药理学是指药理学的学科.
背景情况:
- 静脉血栓栓塞 (VTE) 是医疗住院患者的一个重大风险.
- 血栓预防策略旨在平衡成本,风险和益处.
- 目前用于VTE预防的风险评估模型的有效性各不相同.
研究的目的:
- 评估住院医疗病人的不同血栓预防策略的成本效益.
- 用各种验证模型来比较通用预防,不预防和基于风险的预防.
- 在考虑经济因素的同时,确定预防医疗住院患者VTE的最佳策略.
主要方法:
- 进行了一项决策分析建模研究.
- 评估了药理性血栓预防 (低分子量肝素) 策略.
- 包括普遍预防,没有预防和基于风险的方法,使用像帕多瓦,卡普里尼和IMPROVE这样的模型.
主要成果:
- 全球血栓预防证明>99%的概率是最具成本效益的策略.
- 与没有预防相比,这种策略产生了额外的质量调整寿命年 (QALY) 和潜在的成本节省.
- 基于风险的策略只有在风险评估模型敏感度极高的假设下才具有成本效益.
结论:
- 符合条件的医疗住院患者的全方位药理性血栓预防是最具成本效益的方法.
- 风险评估模型必须达到非常高的灵敏度才能被认为具有成本效益.
- 建议进行广泛的血栓预防,只有在最低风险的患者中例外.
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