| Screening and prevention of venous thromboembolism in critically ill patients: a decision analysis and economic evaluation. | |
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MedLine Citation:
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PMID: 21868500 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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RATIONALE: Venous thromboembolism is difficult to diagnose in critically ill patients and may increase morbidity and mortality. OBJECTIVES: To evaluate the cost-effectiveness of strategies to reduce morbidity from venous thromboembolism in critically ill patients. METHODS: A Markov decision analytic model to compare weekly compression ultrasound screening (screening) plus investigation for clinically suspected deep vein thrombosis (DVT) (case finding) versus case finding alone; and a hypothetical program to increase adherence to DVT prevention. Probabilities were derived from a systematic review of venous thromboembolism in medical-surgical intensive care unit patients. Costs (in 2010 $US) were obtained from hospitals in Canada, Australia, and the United States, and the medical literature. Analyses were conducted from a societal perspective over a lifetime horizon. Outcomes included costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios. MEASUREMENTS AND MAIN RESULTS: In the base case, the rate of proximal DVT was 85 per 1,000 patients. Screening resulted in three fewer pulmonary emboli than case-finding alone but also two additional bleeding episodes, and cost $223,801 per QALY gained. In sensitivity analyses, screening cost less than $50,000 per QALY only if the probability of proximal DVT increased from a baseline of 8.5-16%. By comparison, increasing adherence to appropriate pharmacologic thromboprophylaxis by 10% resulted in 16 fewer DVTs, one fewer pulmonary emboli, and one additional heparin-induced thrombocytopenia and bleeding event, and cost $27,953 per QALY gained. Programs achieving increased adherence to best-practice venous thromboembolism prevention were cost-effective over a wide range of program costs and were robust in probabilistic sensitivity analyses. CONCLUSIONS: Appropriate prophylaxis provides better value in terms of costs and health gains than routine screening for DVT. Resources should be targeted at optimizing thromboprophylaxis. |
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Authors:
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Sachin Sud; Nicole Mittmann; Deborah J Cook; William Geerts; Brian Chan; Peter Dodek; Michael K Gould; Gordon Guyatt; Yaseen Arabi; Robert A Fowler; ; |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2011-08-25 |
Journal Detail:
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Title: American journal of respiratory and critical care medicine Volume: 184 ISSN: 1535-4970 ISO Abbreviation: Am. J. Respir. Crit. Care Med. Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-13 Completed Date: 2012-02-01 Revised Date: 2012-03-23 |
Medline Journal Info:
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Nlm Unique ID: 9421642 Medline TA: Am J Respir Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1289-98 Citation Subset: AIM; IM |
Affiliation:
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Trillium Health Center, Mississauga, Ontario, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Australia Canada Comorbidity Cost-Benefit Analysis Critical Illness / economics*, epidemiology* Decision Support Techniques* Humans Markov Chains Monte Carlo Method Quality-Adjusted Life Years United States Venous Thromboembolism / economics*, epidemiology, prevention & control* |
| Grant Support | |
ID/Acronym/Agency:
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//Canadian Institutes of Health Research |
| Investigator | |
Investigator/Affiliation:
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Brian Chan / ; Deborah Cook / ; Peter Dodek / ; Chip Doig / ; Niall Ferguson / ; Robert Fowler / ; William Geerts / ; Gordon Guyatt / ; Richard Hall / ; Mike Jacka / ; John Marshall / ; Lauralyn McIntyre / ; Sangeeta Mehta / ; Nicole Mittmann / ; John Muscedere / ; Yoanna Skrobik / ; Sachin Sud / ; Jack Cade / ; Jamie Cooper / ; Simon Finfer / ; Neil Oxford / ; Ian Seppelt / ; Michael K Gould / ; James Klinger / ; Nicholas Vlahakis / ; Yaseen Arabi / ; Ismael Qushmaq / ; Marcelo G Rocha / |
| Comments/Corrections | |
Comment In:
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Am J Respir Crit Care Med. 2011 Dec 1;184(11):1227-9
[PMID:
22162884
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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