Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism
Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism
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DOI：
10.3111/13696998.2013.858634
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发表时间：
2014-01
影响因子：
2.4
通讯作者：
P. Lefebvre;C. Coleman;B. Bookhart;Si-Tien Wang;S. Mody;Kevin N. Tran;D. Zhuo;L. Huynh;E. Nutescu
中科院分区：
文献类型：
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作者：
P. Lefebvre;C. Coleman;B. Bookhart;Si-Tien Wang;S. Mody;Kevin N. Tran;D. Zhuo;L. Huynh;E. Nutescu
摘要背景：静脉血栓栓塞（VTE）包括深静脉血栓形成（DVT）和肺栓塞（PE），通常使用低分子量肝素（如依诺肝素）加维生素K拮抗剂（VKA）治疗，以防止复发。依诺肝素+VKA给药受到实验室监测复杂性和频繁剂量调整的阻碍。利伐沙班是一种口服抗凝剂，在EINSTEIN试验中与依诺肝素+VKA进行了比较。目的是评价利伐沙班与依诺肝素+VKA相比作为急性、症状性、客观证实的DVT或PE抗凝治疗的成本-效果。研究方法：建立马尔可夫模型，以评价与依诺肝素+VKA相比，利伐沙班治疗急性DVT或PE成人患者的成本、质量调整生命年（QOL）和增量成本-效果比。所有患者在开始口服利伐沙班或依诺肝素+VKA 3、6或12个月后，以"治疗中"状态进入模型。转移概率是从治疗期间的EINSTEIN试验和治疗后发表的文献中获得的。使用了3个月的周期长度、美国付款人的角度（2012美元）、5年的时间范围和3%的年贴现率。结果如下：与依诺肝素+VKA相比，利伐沙班治疗每例患者的费用少2，448美元，并且与0.0058个QDLS相关，使其成为占主导地位的经济策略。在单向敏感性分析中，与依诺肝素+VKA相比，模型的结果对利伐沙班相关的指标VTE住院时间缩短敏感。在50，000美元/QALY的支付意愿阈值下，概率敏感性分析显示，与依诺肝素+VKA相比，利伐沙班在约76%的时间内具有成本效益。局限性：该模型未考虑与口服和微创给予利伐沙班相关的获益。“现实世界”的适用性是有限的，因为模型中使用了爱因斯坦试验的数据。此外，资源利用率和成本基于美国医疗保健系统。结论：利伐沙班是急性VTE患者抗凝治疗的一种经济有效的选择。
Abstract Background: Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), is commonly treated with a low-molecular-weight heparin such as enoxaparin plus a vitamin K antagonist (VKA) to prevent recurrence. Administration of enoxaparin + VKA is hampered by complexities of laboratory monitoring and frequent dose adjustments. Rivaroxaban, an orally administered anticoagulant, has been compared with enoxaparin + VKA in the EINSTEIN trials. The objective was to evaluate the cost-effectiveness of rivaroxaban compared with enoxaparin + VKA as anticoagulation treatment for acute, symptomatic, objectively-confirmed DVT or PE. Methods: A Markov model was built to evaluate the costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios associated with rivaroxaban compared to enoxaparin + VKA in adult patients treated for acute DVT or PE. All patients entered the model in the ‘on-treatment’ state upon commencement of oral rivaroxaban or enoxaparin + VKA for 3, 6, or 12 months. Transition probabilities were obtained from the EINSTEIN trials during treatment and published literature after treatment. A 3-month cycle length, US payer perspective ($2012), 5-year time horizon and a 3% annual discount rate were used. Results: Treatment with rivaroxaban cost $2,448 per-patient less and was associated with 0.0058 more QALYs compared with enoxaparin + VKA, making it a dominant economic strategy. Upon one-way sensitivity analysis, the model’s results were sensitive to the reduction in index VTE hospitalization length-of-stay associated with rivaroxaban compared with enoxaparin + VKA. At a willingness-to-pay threshold of $50,000/QALY, probabilistic sensitivity analysis showed rivaroxaban to be cost-effective compared with enoxaparin + VKA approximately 76% of the time. Limitations: The model did not account for the benefits associated with an oral and minimally invasive administration of rivaroxaban. ‘Real-world’ applicability is limited because data from the EINSTEIN trials were used in the model. Also, resource utilization and costs were based on the US healthcare system. Conclusion: Rivaroxaban is a cost-effective option for anticoagulation treatment of acute VTE patients.