PCV90 - VENOUS THROMBOEMBOLISM PROPHYLAXIS STRATEGIES FOR ELECTIVE TOTAL HIP REPLACEMENT SURGERY: SYSTEMATIC REVIEW, NETWORK META-ANALYSIS AND COST –UTILITY ANALYSIS TO INFORM NICE CLINICAL GUIDELINE RECOMMENDATION

Abstract Background There is uncertainty about whether cytoreductive surgery (CRS) + hyperthermic intraoperative peritoneal chemotherapy (HIPEC) improves survival and/or quality of life compared to standard of care (SoC) in people with peritoneal metastases who can withstand major surgery. Primary objectives To compare the relative benefits and harms of CRS+HIPEC versus SoC in people with peritoneal metastases from colorectal, ovarian, or gastric cancers eligible to undergo CRS+HIPEC by a systematic review and individual participant data (IPD) meta-analysis. Secondary objectives To compare the cost-effectiveness of CRS+HIPEC versus SoC from a National Health Service (NHS) and personal social services (PSS) perspective using a model-based cost-utility analysis. Methods We will perform a systematic review of literature by updating the searches from MEDLINE, EMBASE, Cochrane library, Science Citation Index as well as trial registers. Two members of our team will independently screen the search results and identify randomised controlled trials (RCTs) comparing CRS+HIPEC versus SoC for inclusion based on full texts for articles shortlisted during screening. We will assess the risk of bias in the trials and obtain data related to baseline prognostic characteristics, details of how CRS+HIPEC and SoC were performed, how long people were followed-up, and outcome data related to overall survival, disease progression, health-related quality of life, treatment related complications, and resource utilisation data by contacting the study authors and obtaining data at the individual participant level. Using individual participant data (IPD), we will perform a two-step IPD, i.e. calculate the adjusted effect estimate from each included study and then perform a random-effects model meta-analysis. We will perform various subgroup analyses and metaregression to investigate potential sources of heterogeneity and identify whether a subset of participants benefits from CRS+HIPEC and perform sensitivity analyses to test the robustness of results to assumptions. We will also perform a model-based cost-utility analysis to assess whether CRS+HIPEC is cost-effective in the NHS setting.

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The cost-effectiveness and cost-utility analysis of the use of enoxaparin compared with heparin for venous thromboembolism prophylaxis in medical inpatients in Iran

DARU Journal of Pharmaceutical Sciences ◽

10.1007/s40199-019-00292-1 ◽

2019 ◽

Vol 27 (2) ◽

pp. 627-634

Author(s):

Mohammadreza Amirsadri ◽

Sarah Mousavi ◽

Ali Karimipour

Keyword(s):

Venous Thromboembolism ◽

Cost Effectiveness ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Thromboembolism Prophylaxis ◽

Venous Thromboembolism Prophylaxis ◽

Medical Inpatients ◽

The Cost

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Cluster Analysis Followed by Network Meta-Analysis to Compare Efficacy and Safety of Dabigatran, Rivaroxaban and Apixaban After Elective Total Knee and Hip Replacement Surgery

Blood ◽

10.1182/blood.v120.21.3409.3409 ◽

2012 ◽

Vol 120 (21) ◽

pp. 3409-3409

Author(s):

Job Harenberg ◽

Svetlana Marx ◽

Shabnam Zolfaghari ◽

Christel Weiss ◽

Martin Wehling ◽

...

Keyword(s):

Cluster Analysis ◽

Major Bleeding ◽

Hip Replacement ◽

Conflicts Of Interest ◽

Meta Analysis ◽

Efficacy And Safety ◽

Duration Of Treatment ◽

Replacement Surgery ◽

Hip Replacement Surgery ◽

Total Knee

Abstract Abstract 3409 The new oral anticoagulant (NOAC) regimens (dabigatran 150mg od (D150) and 220mg od (D220), rivaroxaban 10mg od (R10), and apixaban 2.5mg bid (A5) have shown equivalent or superior efficacy and safety vs enoxaparin regimens for prevention of venous thromboembolism (VTE) following elective total knee (TKR) or hip replacement (THR) surgery. Due to a lack of head to head trials a network meta-analysis (NMA) may give information on a comparison between NOACs. Studies comparing a NOAC with low-molecular-weight heparin for prevention of VTE following TKR and THR were included into the following set of analyses. First, a cluster analysis was performed to identify homogenous groups. Second, only homogeneous studies regarding each endpoint (VTE and VTE related death, major bleeding, and mortality) were included into a meta-analysis for each NOAC regimen. The odds ratio (OR) and 95% confidence interval (CI) were calculated for each NOAC program versus the comparator. Third, these OR and 95% CI were used for the NMA comparing the 4 treatment regimens. First, cluster analysis identified duration of treatment (10+5 and 32+5 days) as the only measure for obtaining homogeneity of trials for every NOAC on every endpoint at 10+5 and 32+5 days (p>0.05) except for A5 and VTE over 10+5 days (analysis not performed). Third, the results of the NMA of the OR and 95% CI of the 4 NOAC regimens over 10+5 days were: D150 and D220 not different on any endpoint; D150 and D220 inferior to R10 for VTE (p<0.01, p<0.001); A5 trend for less major bleeding than R10 (p=0.0546); no differences for the other indirect comparisons. Results for 32+5 days were: D150 and D220 not different on any endpoint; D150 and D220 inferior to R10 VTE (p<0.001, p=0.0015) and to A5 for VTE (p<0.001, p<0001); R10 and A5 not different on VTE. Comparisons of major bleeding and mortality were not different. The lack of a standard definition of VTE and bleeding outcomes between and sometimes within the studies of the NOACs substantially reduce the number of homogenous studies for inclusion into the present NMA using cluster analysis. The differences may help doctors and patients to decide the optimal treatment regimen for individual patient groups. Disclosures: No relevant conflicts of interest to declare.

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