PMID- 25816146
OWN - NLM
STAT- MEDLINE
DCOM- 20160311
LR  - 20181113
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 10
IP  - 3
DP  - 2015
TI  - Impact of thromboprophylaxis across the US acute care setting.
PG  - e0121429
LID - 10.1371/journal.pone.0121429 [doi]
LID - e0121429
AB  - BACKGROUND: The risk of venous thromboembolism (VTE) can be reduced by 
      appropriate use of anticoagulant prophylaxis. VTE prophylaxis does, however, 
      remain substantially underused, particularly among acutely ill medical 
      inpatients. We sought to evaluate the clinical and economic impact of increasing 
      use of American College of Chest Physicians (ACCP)-recommended VTE prophylaxis 
      among medical inpatients from a US healthcare system perspective. METHODS AND 
      FINDINGS: In this retrospective database cost-effectiveness evaluation, a 
      decision-tree model was developed to estimate deaths within 30 days of admission 
      and outcomes attributable to VTE that might have been averted by use of 
      low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). Incremental 
      cost-effectiveness ratio was calculated using "no prophylaxis" as the comparator. 
      Data from the ENDORSE US medical inpatients and the US nationwide Inpatient 
      Sample (NIS) were used to estimate the annual number of eligible inpatients who 
      failed to receive ACCP-recommended VTE prophylaxis. The cost-effectiveness 
      analysis indicated that VTE-prevention strategies would reduce deaths by 0.5% and 
      0.3%, comparing LMWH and UFH strategies with no prophylaxis, translating into 
      savings of $50,637 and $25,714, respectively, per death averted. The ENDORSE 
      findings indicated that 51.1% of US medical inpatients were at ACCP-defined VTE 
      risk, 47.5% of whom received ACCP-recommended prophylaxis. By extrapolating these 
      findings to the NIS and applying cost-effectives analysis results, the full 
      implementation of ACCP guidelines would reduce number of deaths (by 15,875 if 
      using LMWH or 10,201 if using UFH), and was extrapolated to calculate the cost 
      reduction of $803M for LMWH and $262M for UFH. CONCLUSIONS: Efforts to improve 
      VTE prophylaxis use in acutely ill inpatients are warranted due to the potential 
      for reducing VTE-attributable deaths, with net cost savings to healthcare 
      systems.
FAU - Huang, Wei
AU  - Huang W
AD  - Center for Outcomes Research, University of Massachusetts Medical School, 
      Worcester, Massachusetts, United States of America.
FAU - Anderson, Frederick A
AU  - Anderson FA
AD  - Center for Outcomes Research, University of Massachusetts Medical School, 
      Worcester, Massachusetts, United States of America.
FAU - Rushton-Smith, Sophie K
AU  - Rushton-Smith SK
AD  - Center for Outcomes Research, University of Massachusetts Medical School, 
      Worcester, Massachusetts, United States of America.
FAU - Cohen, Alexander T
AU  - Cohen AT
AD  - Department of Haematological Medicine, Guys and St Thomas' NHS Foundation Trust, 
      King's College, London, United Kingdom.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20150327
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/economics/*therapeutic use
MH  - Cost-Benefit Analysis
MH  - Critical Care/economics
MH  - Cross-Sectional Studies
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Pre-Exposure Prophylaxis/*economics/methods
MH  - Prospective Studies
MH  - United States
MH  - Venous Thromboembolism/economics/*prevention & control
PMC - PMC4376674
COIS- Competing Interests: Wei Huang: sanofi. Frederick A. Anderson Jr.: has received 
      research grants from sanofi-aventis and The Medicines Company. He has served as a 
      consultant to GSK and Millennium on the design of outcomes studies. Sophie K. 
      Rushton-Smith: consultancy for Bayer, Sanofi, Boehringer-Ingelheim and 
      Bristol-Myers Squibb. Alexander T. Cohen: Dr. A. T. Cohen is a medical 
      consultant, and has received consultancy and clinical trial funding from many 
      pharmaceutical companies, including Bayer, Boehringer-Ingelheim, BMS, Daiichi, 
      GSK, Johnson and Johnson, Mitsubishi Pharma, Pfizer, Portola, sanofi-aventis, 
      Schering Plough, and Takeda. He is an advisor to the UK Government Health Select 
      Committee, the all-party working group on thrombosis, the Department of Health, 
      and the NHS, on the prevention of VTE. He is also an advisor to Lifeblood: the 
      thrombosis charity and is the founder of the European educational charity the 
      Coalition to Prevent Venous Thromboembolism. This does not alter the authors' 
      adherence to PLOS ONE policies on sharing data and materials.
EDAT- 2015/03/31 06:00
MHDA- 2016/03/12 06:00
PMCR- 2015/03/27
CRDT- 2015/03/28 06:00
PHST- 2014/05/13 00:00 [received]
PHST- 2015/02/17 00:00 [accepted]
PHST- 2015/03/28 06:00 [entrez]
PHST- 2015/03/31 06:00 [pubmed]
PHST- 2016/03/12 06:00 [medline]
PHST- 2015/03/27 00:00 [pmc-release]
AID - PONE-D-14-20826 [pii]
AID - 10.1371/journal.pone.0121429 [doi]
PST - epublish
SO  - PLoS One. 2015 Mar 27;10(3):e0121429. doi: 10.1371/journal.pone.0121429. 
      eCollection 2015.