Levin L A, Horst M, Bergqvist D
Department of Health and Society, Tema Research, Linköping University, Sweden.
Pharmacoeconomics. 1998 Jan;13(1 Pt 2):111-8. doi: 10.2165/00019053-199813010-00010.
Deep vein thrombosis is a serious complication of orthopaedic surgery and can lead to pulmonary embolism and long term post-thrombotic syndrome. A simulation model based on both epidemiological data and data from clinical trials was used to compare the long term cost effectiveness of standard prophylaxis with subcutaneous unfractionated heparin with that of desirudin (recombinant hirudin), in patients undergoing elective hip replacement. The analysis, which was performed before the price of desirudin was set, showed that prophylactic treatment with desirudin saved 4.5 life-years per 100 patients treated, compared with unfractionated heparin. Desirudin prophylaxis was dominant up to a total drug cost of 4400 Swedish kronor (SEK) per treatment. The results were robust against changes in the parameters used in several sensitivity analyses. This study showed that prophylactic therapy with desirudin compared with unfractionated heparin was more cost effective and potentially cost saving under a wide range of assumptions concerning the future price of desirudin in preventing deep vein thrombosis following elective hip surgery.
深静脉血栓形成是骨科手术的一种严重并发症，可导致肺栓塞和长期血栓后综合征。在接受择期髋关节置换术的患者中，使用基于流行病学数据和临床试验数据的模拟模型，比较皮下注射普通肝素进行标准预防与地西卢定（重组水蛭素）的长期成本效益。在确定地西卢定价格之前进行的分析表明，与普通肝素相比，地西卢定预防治疗每治疗100例患者可挽救4.5个生命年。在地西卢定每次治疗的总药物成本高达4400瑞典克朗（SEK）时，地西卢定预防是占优的。在多项敏感性分析中使用的参数发生变化时，结果依然稳健。这项研究表明，在关于地西卢定未来价格的广泛假设下，与普通肝素相比，地西卢定预防治疗在预防择期髋关节置换术后深静脉血栓形成方面更具成本效益，并且可能节省成本。
