R Othieno, M Abu Affan, E Okpo
DOI:10.1002/14651858.CD003076.pub2
Add feedback to this review/protocol
This review seeks to provide evidence on the costs and cost-effectiveness of the different treatment options. To do this data from the economic evaluations conducted alongside the systematic review are abstracted and presented. Although the intention is laudable the information is abstracted and presented in an uncritical fashion. If such data are too be presented it should be reported in a more complete fashion and should be critically appraised so that strengths and weaknesses are identified. Methods to critically appraise economic evaluations are well established and numerous guidelines exist e.g. Drummond M F, Jefferson T O for the BMJ Working Party on guidelines for authors and peer-reviewers of economic submissions to the British Medical Journal. Guidelines for authors and peer-reviewers of economic submissions to the British Medical Journal. BMJ 1996; 313:275-83 (3 August). (downloadable from the BMJ website.).
A fuller description of the cost and cost-effectiveness data will only help readers make more use of this review. If any clarification is needed about this point the reviewers are welcome to contact myself or other members of the Economic Methods Group
I certify that I have no affiliations with or involvement in any organisation or entity with a direct financial interest in the subject matter of my criticisms.
Date received: August 1, 2007
Cite this comment as: http://www.cochranefeedback.com/cf/cda/citation.do?id=9699#9699
Hospital treatment of DVT with anticoagulants (the control arm) is not evidence-based to be safe or effective.1-6 None of the only three RCTs of heparin and vitamin K antagonists with un-anticoagulated controls showed any benefit with anticoagulants.7-10 Therefore, home anticoagulation treatment for DVT (the experimental group) is not proven to be safe and effective.
1. Cundiff DK, Manyemba J, Pezzullo JC. Anticoagulants versus non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism. The Cochrane Database of Systematic Reviews. 2006;Issue 1. Art. No.: CD003746. DOI: 10.1002/14651858.CD003746.pub2.
2. Cundiff DK, Manyemba J. Anticoagulants versus non steroidal anti-inflammatories or placebo for treatment of venous thromboembolism. (Protocol). Cochrane Database Syst. Review.2002 (3):http://www.update-software.com/cochrane/default.htm.
3. Cundiff DK. Letters to Editor re Anticoagulation Therapy for Venous Thromboembolism. Medscape General Medicine. January 3, 2005;6(4):http://www.medscape.com/viewarticle/496148.
4. Cundiff DK. Reply to Letters re Anticoagulation Therapy for Venous Thromboembolism. Medscape General Medicine. January 3, 2005;6(4):http://www.medscape.com/viewarticle/496149.
5. Cundiff DK. Evidence-based Medicine and the Cochrane Collaboration on Trial. MedGenMed. June 12, 2007;9(2):http://medgenmed.medscape.com/viewarticle/557263.
6. Lundberg GD. Is the Current Standard of Medical Practice for Treating Venous Thromboembolism Simply Wrong? MedGenMed. September 9, 2004;6(3):http://www.medscape.com/viewarticle/488717.
7. Nielsen HK, Husted SE, Krusell LR, Fasting H, Charles P, Hansen HH. Silent pulmonary embolism in patients with deep venous thrombosis. Incidence and fate in a randomized, controlled trial of anticoagulation versus no anticoagulation. Journal of Internal Medicine. 1994;235(5):457-461.
8. Nielsen HK, Husted SE, Krusell LR, et al. Anticoagulant therapy in deep venous thrombosis. A randomized controlled study. Thrombosis Research. 1994;73(3-4):215-226.
9. Ott P, Eldrup E, Oxholm P. The value of anticoagulant therapy in deep venous thrombosis in the lower limbs in elderly, mobilized patients. A double-blind, placebo-controlled investigation with open therapeutic guidance. Ugeskr Laeger. 1988;150:218-221.
10. Kakkar VV, Flanc C, O'Shea M, Flute P, Howe CT, Clarke MB. Treatment of deep-vein thrombosis--a random trial. Br J Surg. 1968;55(11):858.