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(Chest. 2003;124:393S-396S.)
© 2003 American College of Chest Physicians

The Economics of Venous Thromboembolism Prophylaxis*

A Primer for Clinicians

Bruce L. Davidson, MD, MPH, FCCP; Sean D. Sullivan, PhD; Susan R. Kahn, MD, MSc; Lars Borris, MD; Patrick Bossuyt, PhD and Gary Raskob, PhD

* From the Pulmonary and Critical Care Medicine Division (Dr. Davidson), Swedish Medical Center and University of Washington School of Medicine, Seattle, WA; Pharmaceutical Outcomes Research and Policy Program (Dr. Sullivan), University of Washington, Seattle, WA; Sir Mortimer B. Davis Jewish General Hospital (Dr. Kahn), Montreal, QC, Canada; Aarhus University Hospital (County) (Dr. Borris), Aarhus, Denmark; Academic Medical Center (Dr. Bossuyt), Amsterdam, the Netherlands; and College of Public Health (Dr. Raskob), University of Oklahoma Health Sciences Center, Oklahoma City, OK.

Correspondence to: Bruce L. Davidson, MD, MPH, FCCP, 801 Broadway, Suite 915, Seattle, WA 98122; e-mail: brucedavidson{at}pobox.com

Cost-effectiveness information can help health-system participants make decisions about diagnostic or therapeutic innovations that are more expensive but incrementally safe and effective. However, these analyses cannot help decide whether a less expensive approach is "sufficient" and funds ought to be allocated to other medical issues entirely. At present, formulary committees are commonly determining that medications are "mostly equivalent" in efficacy and safety and choosing individual medications or classes of medications based on cost. Clinicians may not agree with these decisions and will need to understand their rationale. For prophylaxis of venous thromboembolism after hip and knee replacement and hip fracture surgery, many preventive modalities are available with different safety and efficacy profiles and different costs. It is possible to list the important safety and efficacy outcomes of prophylaxis, estimate their incidences and costs, and "model" comparisons of one modality vs another, in order to help decide whether one is preferable.

Key Words: cost-effectiveness • deep-vein thrombosis • health economics • pulmonary embolism • venous thromboembolism




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