Economic evaluation of a specialized model of care versus usual care for patients with venous thromboembolism: a systematic review and cost-effectiveness analysis
Bibliographic record
Abstract
Venous thromboembolism (VTE) is the third most common cause of cardiovascular related mortality and is responsible for considerable morbidity. Specialized thrombosis and anticoagulation care models have shown potential to improve patient outcomes and minimize overall anticoagulation-related healthcare resource utilization. However, there is limited evidence on the cost-effectiveness of utilizing a specialized care model versus usual care for patients with VTE. This thesis seeks to accomplish two main objectives: first, to conduct a systematic review to understand the economic implications of specialized models of care for patients with VTE compared to usual care and second, to conduct a cost-effectiveness analysis of a comprehensive specialized thrombosis and anticoagulation care model versus usual care for patients with newly diagnosed VTE in Newfoundland and Labrador (NL)’s largest health region. In the systematic review, existing economic evaluation studies that compared a specialized care model against usual care for patients with VTE were evaluated. The included studies were narratively summarized according to specialized care model type, patient population and economic evaluation type. We assessed the quality of the included studies and found that the majority of studies were low-quality economic evaluation studies (> 75%). Additionally, the review highlighted the lack of studies evaluating a comprehensive care model, and that existing evidence is based on less contemporary therapies, such as warfarin. In the cost effectiveness analysis, we compared a comprehensive specialized thrombosis and anticoagulation management care model (the Thrombosis Service) versus usual care for patients with newly diagnosed VTE from the healthcare and societal perspective. Effectiveness was measured in quality-adjusted life-years (QALY). The comprehensive specialized thrombosis and anticoagulation management care model was found to be the dominant strategy over usual care with a 93% probability to be cost-effective across various willingness-to-pay threshold. Conclusion: The results of the systematic review and the cost-effectiveness study indicate that specialized care models are associated with better clinical and economic outcomes compared to usual care. These results are of significant importance for clinicians and policymakers tasked with optimizing care and ensuring appropriate resource allocation to reduce inefficiencies for a sustainable care pathway for patients with VTE.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.072 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.022 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".