Honorato Jesús, Gómez-Outes Antonio, Navarro-Quilis Antonio, Martínez-González Javier, Rocha Eduardo, Planès André
University Clinic of Navarra, Pamplona, Spain.
Pharmacoeconomics. 2004;22(13):885-94. doi: 10.2165/00019053-200422130-00006.
Low molecular weight heparins are effective and have a good tolerability profile as first-line prophylaxis for venous thromboembolism (VTE) in major orthopaedic surgery. However, pharmacological inequivalence within the class could lead to differences in cost-effectiveness ratios.
To quantify the potential economic impact of subcutaneous bemiparin sodium 3500 IU/day compared with enoxaparin sodium 40 mg/day as prophylaxis for VTE in patients undergoing total knee replacement (TKR) surgery, considering both in-hospital and post-discharge outcomes and costs during 6 weeks of postoperative follow-up.
A cost-effectiveness analysis was performed using a decision modelling approach. The results were expressed in terms of costs and incremental cost effectiveness in Euro (2002 values). The treatment costs (hospital stay, physician services, drug administration) and costs incurred due to complications such as pulmonary embolism and/or proximal deep vein thrombosis, bleeding events, wound haematoma and thrombocytopenia were considered for this analysis. The target population comprised all adult patients undergoing TKR surgery included in a previous clinical trial (n = 381). The study was conducted in the setting of the Spanish National Health System. The time horizon chosen was 6 weeks.
Bemiparin provided cost savings of Euro144.48 per patient compared with enoxaparin when costs derived from treatment and complications during the 6-week postoperative period were considered (Euro4675.01 vs Euro4819.49). Pharmacy costs per patient were lower for bemiparin during hospital stay (Euro43.34 vs Euro50.20; difference, Euro-6.86) and for post-discharge prophylaxis (Euro68.63 vs Euro87.78; difference Euro-19.15). Bemiparin was calculated to avoid 42 additional VTE events per 1000 patients treated at 6 weeks. The incremental cost-effectiveness analysis indicated that bemiparin was dominant over enoxaparin, producing better outcomes and cost savings. The sensitivity analysis supported the cost effectiveness of bemiparin in all the ranges tested for complications and costs.
Our model suggests, based on its underlying assumptions and data, that bemiparin may be more cost effective than enoxaparin for thromboprophylaxis in total knee replacement surgery in the Spanish healthcare setting.
低分子量肝素作为主要骨科手术中静脉血栓栓塞症（VTE）的一线预防用药，疗效显著且耐受性良好。然而，该类药物之间的药理学非等效性可能导致成本效益比存在差异。
比较皮下注射贝米肝素钠3500 IU/天与依诺肝素钠40 mg/天对全膝关节置换术（TKR）患者预防VTE的效果，同时考虑术后6周随访期间的住院及出院后结局和成本，以量化其潜在经济影响。
采用决策建模方法进行成本效益分析。结果以成本和增量成本效益（2002年欧元价值）表示。本分析考虑了治疗成本（住院时间、医生服务、药物管理）以及因并发症（如肺栓塞和/或近端深静脉血栓形成、出血事件、伤口血肿和血小板减少症）产生的成本。目标人群包括先前一项临床试验中纳入的所有接受TKR手术的成年患者（n = 381）。该研究在西班牙国家卫生系统环境中进行。选择的时间范围为6周。
在考虑术后6周期间治疗和并发症产生的成本时，与依诺肝素相比，贝米肝素使每位患者节省成本144.48欧元（4675.01欧元对4819.49欧元）。住院期间，贝米肝素的每位患者药房成本较低（43.34欧元对50.20欧元；差值为-6.86欧元），出院后预防用药成本也较低（68.63欧元对87.78欧元；差值为-19.15欧元）。据计算，每1000例接受治疗的患者在6周时，贝米肝素可额外避免42例VTE事件。增量成本效益分析表明，贝米肝素优于依诺肝素，效果更好且成本更低。敏感性分析支持了贝米肝素在所有测试的并发症和成本范围内的成本效益。
基于其基本假设和数据，我们的模型表明，在西班牙医疗环境下，全膝关节置换手术中，贝米肝素在预防血栓形成方面可能比依诺肝素更具成本效益。
