Low-molecular-weight heparin versus warfarin for secondary prophylaxis of venous thromboembolism: A cost-effectiveness analysis
Low-molecular-weight heparin versus warfarin for secondary prophylaxis of venous thromboembolism: A cost-effectiveness analysis
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DOI：
10.1016/s0002-9343(01)00793-8
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发表时间：
2001-08-01
影响因子：
5.9
通讯作者：
Barosi, G
中科院分区：
文献类型：
--
作者：
Marchetti, M;Pistorio, A;Barosi, G
目得：比较低分子量肝素与口服抗凝剂在预防静脉血栓栓塞后复发的成本效益。方法：根据6项已发表的试验的汇总数据，使用决策树评估低分子量肝素或华法林治疗后的成本和预期质量调整生命年数（QALY）。结果：与华法林相比，低分子肝素显著降低了轻微出血的发生率（比值比[OR] = 0.24; 95%置信区间[CI]：0.14 - 0.43），但不包括复发性深静脉血栓形成（OR = 0.77; 95% CI：0.43 - 1.35）。患者对华法林的偏好（0. 988，0到I量表）低于低分子量肝素（0. 992），但差异无统计学意义。Monte Carlo分析估计，与华法林相比，低分子量肝素平均节省13个质量调整天数，基于意大利的成本，每个QALY的成本为6，583美元（95% CI：5，525美元至7，625美元），基于美国的成本，每个QALY的成本为28，231美元（93% CI：20，872美元至36，773美元）。当我们纳入治疗中断后的反弹复发时，低分子量肝素更常见，在意大利，低分子量肝素治疗每QALY的成本为53，166美元，在美国为177，166美元。低分子肝素可能是静脉血栓栓塞二级预防的一种经济有效的药物，特别是在复发风险高和药物成本较低的患者中。在推荐常规使用低分子肝素之前，需要更彻底地研究中断治疗后复发率的明显增加。(C)2001年，Excerpta Medica，Inc.
PURPOSE: To compare the cost effectiveness of low-molecular-weight heparin with that of oral anticoagulants in preventing recurrences after an episode of venous thromboembolism.METHODS: A decision tree was used to assess the cost and the expected quality-adjusted years of life (QALY) after treatment with either low-molecular-weight heparin or warfarin, based on pooled data from six published trials. Preferences were elicited with a modified time trade-off method in a sample of patients attending an anticoagulation clinic.RESULTS: Compared with warfarin, low-molecular-weight heparin significantly decreased the rate of minor bleeding (odds ratio [OR] = 0.24; 95% confidence interval [CI]: 0.14 to 0.43) but not recurrent deep vein thromboses (OR = 0.77; 95% CI: 0.43 to 1.35). Patients' preference for warfarin (0.988, on a 0 to I scale) was lower than that for low-molecular-weight heparin (0.992), but the difference was not statistically significant. A Monte Carlo analysis estimated that low-molecular-weight heparin saved an average of 13 quality-adjusted days compared with warfarin, at a cost of $6,583 per QALY (95% CI: $5,525 to $7,625) based on costs in Italy and $28,231 per QALY (93% CI: $20,872 to $36,773) based on costs in the United States. When we included rebound recurrences after interruption of therapy, which were more common with low-molecular-weight heparin, treatment with low-molecular-weight heparin cost $53,166 per QALY in Italy and $177,166 per QALY in the United States.CONCLUSIONS: Low-molecular-weight heparin might be a cost-effective drug for secondary prophylaxis of venous thromboembolism, especially in patients at high risk of recurrence and where the drug's cost is lower. The apparent increase in recurrence after interruption of therapy needs to be investigated more thoroughly before low-molecular-weight heparin can be recommended routinely. (C) 2001 by Excerpta Medica, Inc.