PMID- 21752434
OWN - NLM
STAT- MEDLINE
DCOM- 20110926
LR  - 20110808
IS  - 1095-6859 (Electronic)
IS  - 0090-8258 (Linking)
VI  - 122
IP  - 3
DP  - 2011 Sep
TI  - Cost comparison of strategies for the management of venous thromboembolic event 
      risk following laparotomy for ovarian cancer.
PG  - 467-72
LID - 10.1016/j.ygyno.2011.06.014 [doi]
AB  - OBJECTIVE: To evaluate the costs and effectiveness of thromboprophylaxis 
      strategies following laparotomy for ovarian cancer. METHODS: We constructed a 
      decision model to evaluate six strategies for management of postoperative venous 
      thromboembolism (VTE) risk: (1) no thromboprophylaxis; (2) inpatient sequential 
      compression device (SCD); (3) inpatient unfractionated heparin (UFH) 5000 units 
      TID; (4) inpatient low molecular weight heparin (LMWH) 40 mg daily; (5) UFH 5000 
      units TIDx1 month; (6) LMWH 40 mg dailyx1 month. Rates of VTE, heparin-induced 
      thrombocytopenia, and significant bleeding for each strategy were obtained from 
      published literature. Costs were based on institutional charges or obtained from 
      the Agency for Healthcare Research and Quality Nationwide Inpatient Sample 
      database for 2008 and average wholesale pricing. Sensitivity analyses were 
      performed to account for uncertainty in estimates. RESULTS: In the base case, 
      UFHx1 month was the least expensive (mean cost $1611) and most effective (VTE 
      risk 1.9%) strategy. LMWHx1 month was equally effective but more expensive 
      ($2197). Inpatient UFH, inpatient LMWH, and SCDs were less effective and more 
      expensive than UFHx1 month. In the sensitivity analysis, cost rankings remained 
      unchanged unless the baseline probability of VTE was assumed <6.5%, the cost of 
      VTE treatment was <$20,000, or the cost of bleeding was >$4500. LMWHx1 month 
      became least expensive when cost was decreased 38%. CONCLUSION: Based on current 
      evidence, extended prophylaxis with UFH is the least expensive and most effective 
      strategy to prevent postoperative VTE following laparotomy for ovarian cancer.
CI  - Copyright (c) 2011 Elsevier Inc. All rights reserved.
FAU - Teoh, Deanna
AU  - Teoh D
AD  - Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 
      27710, USA. deanna.teoh@duke.edu
FAU - Berchuck, Andrew
AU  - Berchuck A
FAU - Alvarez Secord, Angeles
AU  - Alvarez Secord A
FAU - Lee, Paula S
AU  - Lee PS
FAU - Lowery, William J
AU  - Lowery WJ
FAU - Sfakianos, Gregory P
AU  - Sfakianos GP
FAU - Valea, Fidel A
AU  - Valea FA
FAU - Myers, Evan R
AU  - Myers ER
FAU - Havrilesky, Laura J
AU  - Havrilesky LJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20110712
PL  - United States
TA  - Gynecol Oncol
JT  - Gynecologic oncology
JID - 0365304
SB  - IM
CIN - Gynecol Oncol. 2011 Sep;122(3):465-6. PMID: 21821169
MH  - Comparative Effectiveness Research
MH  - Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Decision Trees
MH  - Female
MH  - *Health Care Costs
MH  - Humans
MH  - Laparotomy/adverse effects/economics
MH  - Models, Economic
MH  - Ovarian Neoplasms/*blood/*economics/surgery
MH  - Risk Factors
MH  - Venous Thrombosis/*economics/etiology/*prevention & control
EDAT- 2011/07/15 06:00
MHDA- 2011/09/29 06:00
CRDT- 2011/07/15 06:00
PHST- 2011/05/16 00:00 [received]
PHST- 2011/06/05 00:00 [revised]
PHST- 2011/06/08 00:00 [accepted]
PHST- 2011/07/15 06:00 [entrez]
PHST- 2011/07/15 06:00 [pubmed]
PHST- 2011/09/29 06:00 [medline]
AID - S0090-8258(11)00452-5 [pii]
AID - 10.1016/j.ygyno.2011.06.014 [doi]
PST - ppublish
SO  - Gynecol Oncol. 2011 Sep;122(3):467-72. doi: 10.1016/j.ygyno.2011.06.014. Epub 
      2011 Jul 12.