Postpartum Olgularda Venöz Tromboemboli Profilaksi Amacıyla Uygulanan Düşük Moleküler Ağırlıklı Heparinin Maliyet Etkililik Analizi

Abstract

Changes in the coagulation system during pregnancy increase the risk of thromboembolic events (DVT or PTE), and the susceptibility to venous thrombosis increases in women in the postpartum period. Early mobilization as a preventive measure, supportive stockings, and avoiding dehydration are the measures used to reduce this risk. However, these measures are not sufficient, especially in cases with additional risk factors. For this reason, to reduce the mortality and morbidity of the mother in postpartum women who are identified in the middle or high-risk group according to the risk assessment and scoring system recommended in both the guidelines recommended by international organizations and the Risky Pregnancy Management Guidelines of the Ministry of Health, which are still in use, it usually starts from the use of low molecular weight heparin (LMWH) is recommended for the 10 days to 42 days according to the risk score. This means the application of LMWH to an average of 300-350 thousand patients who were delivered with an emergency cesarean section indication, and this practice causes a significant cost. Therefore, within the scope of this thesis, it was aimed to investigate the cost-effectiveness of LMWH applied for prophylaxis in postpartum cases. A total of 701 cases in the postpartum period were included in the study. The cost data of the study were obtained from the invoices of the patients through the hospital automation program. The indirect costs of the patients were obtained from the patients in the interviews. In the research, the analyzes were made from the perspective of the reimbursement institution, taking into account the direct expenses, and also included the indirect expenses of the patients and evaluated with a broader perspective. An analysis method based on the decision tree model was applied in the cost-effectiveness (CE) analysis. In the study, the development of VTE complications within a 6-week period was evaluated in the group that used and did not use LMWH prophylaxis. The effectiveness, probability, and cost inputs in the models were obtained from the data obtained within the scope of the research. However, since no patient with suspected or diagnosed VTE was encountered during the research, secondary data were used in the data of these patients. Therefore, the probability and effectiveness, cost data for these patients were taken from the literature.

When CE results are evaluated; In the economic model based on LMWH prophylaxis options, it can be said that the treatment option not to receive LMWH prophylaxis is a more dominant strategy than the option to receive LMWH prophylaxis. In the economic model established according to the VTE risk assessment scores, it can be said that the current protocol should be continued because it necessitates the use of LMWH in the high-risk group, even if the method applied for the patients in the low-risk group is considered to be a dominant strategy. Therefore, it is thought that the results obtained from this thesis study will contribute to the studies on the effectiveness and economic results of LMWH.