Cost-Effectiveness of Prevention and Treatment of VTE

Nicolaides, Andrew; Fareed, Jawed; Kakkar, Ajay K.; Comerota, Anthony J.; Goldhaber, Samuel Z.; Hull, Russell D.; Myers, K.; Samama, M; Fletcher, Jane; Kalodiki, Evi; Bergqvist, David; Bonnar, J.; Caprini, Joseph A.; Carter, C.; Conard, J.; Eklöf, Bo; Elalamy, Ismaı̈l; Gerotziafas, G.; Geroulakos, George; Giannoukas, A.; Greer, I. A.; Griffin, Molly; Kakkos, S.; Lassen, Michael R.; Lowe, G. D. O.; Markel, Arie; Prandoni, Paolo; Raskob, Gary E.; Spyropoulos, Alex C.; Turpie, Alexander G.G.; Walenga, Jeanine M.; Warwick, David

doi:10.1177/1076029612474840w

Cited by 7 publications

(7 citation statements)

References 63 publications

(118 reference statements)

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“…4,9,10 Chemical thromboprophylaxis can prevent hospital-acquired VTE and is demonstrably cost-effective when compared to no prophylaxis. 11 Guidelines designed to address the public health burden associated with hospital-acquired VTE recommend patients be assessed for thrombosis and bleeding risk on admission to the hospital. Those with a favorable risk-benefit profile should have chemoprophylaxis administered.…”

Section: Introductionmentioning

confidence: 99%

Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score

Hostler

Moores

et al. 2016

Chest

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Section: Introductionmentioning

confidence: 99%

Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score

Hostler

Moores

et al. 2016

Chest

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“…These ndings suggest that thromboprophylaxis is inadequate in hospitalised patients with VTE risk, especially appropriate thromboprophylaxis, and that low-risk patients are at risk of over prophylaxis. Appropriate thromboprophylaxis is a life-saving and cost-effective strategy, [25] which requires consideration of availability, cost, patient preference, compliance, comorbidities, and other factors.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of an Artificial Intelligence Clinical Assistant Decision Support System to Improve the Incidence of Hospital-Associated Venous Thromboembolism: A Prospective, Randomised Controlled Study

Huang

Zhou

et al. 2022

Preprint

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Background Thromboprophylaxis has been determined to be safe, effective, and cost-effective for hospitalised patients at venous thromboembolism (VTE) risk. However, Chinese medical institutions have not yet fully utilised or improperly used thromboprophylaxis given the lack of prospective studies; thus, more trials are needed. Methods All hospitalised patients aged >18 years not discharged within 24 h from 1 September 2021 to 31 May 2021 were prospectively enrolled. Patients were randomly assigned to the control (9,890 patients) or intervention group (9,895 patients). The control group implemented conventional VTE prevention programmes; the intervention group implemented an Artificial Intelligence Clinical Assistant Decision Support System (AI-CDSS) on the basis of conventional prevention. Intergroup demographics, disease status, hospital length of stay (LOS), VTE risk assessment, and VTE prophylaxis were compared using the chi-square test, Fisher’s exact test, t-test, or Wilcoxon rank-sum test. Results The control and intervention groups had similar baseline characteristics. The mean age was 58.32±15.41 years, and mean LOS was 7.82±7.07 days. In total, 5027 (25.40%) and 2707 (13.67%) patients were assessed as having intermediate-to-high VTE risk and high bleeding risk, respectively The incidence of hospital-associated VTE (HA-VTE) was 0.38%, of which 86.84% had DVT. Compared to the control group, the incidence of HA-VTE decreased by 46.00%, mechanical prophylaxis rate increased by 24.00%, and intensity of drug use increased by 9.72% in the intervention group. However, AI-CDSS use did not increase the number of clinical diagnostic tests, prophylaxis rate, or appropriate prophylaxis rate. Conclusions AI-CDSS showed a positive role in VTE risk management. Thus, it is necessary to implement evidence-based education programmes to increase physicians’ awareness of thromboprophylaxis and appropriate thromboprophylaxis rates. Trial registration This was a randomised controlled single-centre prospective study , which has been reviewed by the World Health Organization International Clinical Trial Registration Platform (11/8/2020, ChiCTR2000035452).

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“…) and that VTE prophylaxis has been found to be cost‐effective as compared to no prophylaxis or case detection (Nicolaides et al. ), it is in the financial interest of the hospital to take measures to prevent VTEs.…”

Section: Discussionmentioning

confidence: 99%

Impact of Medicare's Nonpayment Program on Venous Thromboembolism Following Hip and Knee Replacements

Thirukumaran

Glance

Rosenthal

et al. 2018

Health Services Research

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Objective To determine whether Medicare's Nonpayment Program was associated with decline in venous thromboembolism (VTE) following hip and knee replacements; and whether the decline was greater among hospitals at risk of larger financial losses from the Program. Data Sources State Inpatient Database for New York (NY) from 2005 to 2013. Study Design The primary outcome was an occurrence of VTE. Medicare Utilization Ratio (MUR), which is the proportion of inpatient days in a hospital that is financed by Medicare, represented a hospital's financial sensitivity. We used hierarchical logistic regressions with difference‐in‐differences estimation to study the Program effects. Principal Findings A total of 98,729 hip replacement and 111,361 knee replacement stays were identified. For hip replacement, the Program was associated with significant reduction (Range: 44% to 53%) in VTE incidence among hospitals in MUR quartiles 2 to 4. For knee replacement, the Program was associated with significant reduction (47%) in VTE incidence only among quartile 2 hospitals. Conclusion Implementation of the Program was associated with a reduction in VTE, especially for hip replacements, in higher MUR hospitals. Payment reforms such as Medicare's Nonpayment Program that withhold payments for complications are effective and should be continued.

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Cost-Effectiveness of Prevention and Treatment of VTE

Abstract: Statements and recommendations made in this document are based on a literature review using clearly defined levels of evidence. This process has revealed a number of key questions that need to be addressed by future studies. They are summarized in this final section.

Cited by 7 publications

References 63 publications

Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score

Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score

Effectiveness of an Artificial Intelligence Clinical Assistant Decision Support System to Improve the Incidence of Hospital-Associated Venous Thromboembolism: A Prospective, Randomised Controlled Study

Impact of Medicare's Nonpayment Program on Venous Thromboembolism Following Hip and Knee Replacements

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