Evidence map›Paper›PMID 25927574›Full record

SynthesisCritical care (London, England)2012

Economic analyses of venous thromboembolism prevention strategies in hospitalized patients: a systematic review.

Subarna Thirugnanam, Ruxandra Pinto, Deborah J Cook, William H Geerts, Robert A Fowler

Open access · goldAbstract readSystematic Review
In one paragraph

Synthesis in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
1.1field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it, 21 citations in OpenAlex.

  1. Industry sponsorship and research outcome.The Cochrane database of systematic reviews · 2017
    Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Article
  6. Artificial Intelligence-Based Prediction of Lower Extremity Deep Vein Thrombosis Risk After Knee/Hip Arthroplasty.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 2 countries.

Subarna ThirugnanamDepartment of Medicine, University of Toronto, Toronto, Ontario, Canada. subarna.thirugnanam@utoronto.ca.
Ruxandra PintoDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Ruxandra.Pinto@sunnybrook.ca.
Deborah J CookDepartment of Medicine, St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada. debcook@mcmaster.ca.
William H GeertsDepartment of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. William.geerts@sunnybrook.ca.
Robert A FowlerDepartment of Medicine, St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada. rob.fowler@sunnybrook.ca.
St. Joseph Hospital · USSunnybrook Health Science Centre · CAUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionDespite evidence-based guidelines for venous thromboembolism prevention, substantial variability is found in practice. Many economic evaluations of new drugs for thromboembolism prevention do not occur prospectively with efficacy studies and are sponsored by the manufacturers, raising the possibility of bias. We performed a systematic review of economic analyses of venous thromboembolism prevention in hospitalized patients to inform clinicians and policy makers about cost-effectiveness and the potential influence of sponsorship.

methodsWe searched MEDLINE, EMBASE, Cochrane Databases, ACP Journal Club, and Database of Abstracts of Reviews of Effects, from 1946 to September 2011. We extracted data on study characteristics, quality, costs, and efficacy.

resultsFrom 5,180 identified studies, 39 met eligibility and quality criteria. Each addressed pharmacologic prevention: low-molecular-weight heparins versus placebo (five), unfractionated heparin (12), warfarin (eight), one or another agents (five); fondaparinux versus enoxaparin (11); and rivaroxaban and dabigatran versus enoxaparin (two). Low-molecular-weight heparins were most economically attractive among most medical and surgical patients, whereas fondaparinux was favored for orthopedic patients. Fondaparinux was associated with increased bleeding events. Newer agents rivaroxaban and dabigatran may offer additional value. Of all economic evaluations, 64% were supported by manufacturers of a "new" agent. The new agent had a favorable outcome in 38 (97.4%) of 39 evaluations [95% confidence interval [CI] (86.5 to 99.9)]. Among studies supported by a pharmaceutical company, the sponsored medication was economically attractive in 24 (96.0%) of 25 [95% CI, 80.0 to 99.9)]. We could not detect a consistent bias in outcome based on sponsorship; however, only a minority of studies were unsponsored.

conclusionLow-molecular-weight heparins and fondaparinux are the most economically attractive drugs for venous thromboembolism prevention in hospitalized patients. Approximately two thirds of evaluations were supported by the manufacturer of the new agent; such drugs were likely to be reported as economically favorable.

Indexed as

Practice Guidelines as TopicAnticoagulantsCost-Benefit AnalysisEnoxaparinFondaparinuxHeparin, Low-Molecular-WeightHospitalizationHumansPolysaccharidesVenous ThromboembolismAnticoagulantsEnoxaparinFondaparinuxHeparin, Low-Molecular-WeightPolysaccharides

Identifiers

PMID25927574
PMCPMC3964799
OpenAlexW2163358770

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.