Sullivan Sean D, Kwong Louis, Nutescu Edith
Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA 98195, USA.
Value Health. 2006 Mar-Apr;9(2):68-76. doi: 10.1111/j.1524-4733.2006.00085.x.
To evaluate the cost-effectiveness of fondaparinux relative to enoxaparin as prophylaxis against venous thromboembolism (VTE) in patients undergoing hip fracture surgery.
A decision analysis model was created to simulate the impact of fondaparinux 2.5 mg once daily relative to enoxaparin 30 mg twice daily on patient outcomes and costs over various time points up to 5 years after surgery. Probabilities for the analysis were estimated for a hypothetical cohort of 1000 patients undergoing hip fracture surgery in the United States receiving either fondaparinux or enoxaparin according to comparative trial results. Resource use and costs (2003 dollars) were obtained from large health-care databases. Outcome measures were rates of symptomatic VTE events, health-care costs, and incremental cost-effectiveness ratios.
Fondaparinux is estimated to prevent an additional 30 VTE events (per 1000 patients) at 3 months compared with enoxaparin, producing savings of 103 dollars at discharge, 290 dollars over 1 month, 361 dollars over 3 months, and 466 dollars over 5 years. The results remain robust to clinically plausible variation in input parameters and assumptions.
Fondaparinux improves outcomes and is cost-saving over a broad range of assumptions compared with enoxaparin for prophylaxis of VTE after hip fracture surgery.
评估磺达肝癸钠相对于依诺肝素在预防髋部骨折手术患者静脉血栓栓塞（VTE）方面的成本效益。
建立一个决策分析模型，以模拟每日一次使用2.5 mg磺达肝癸钠相对于每日两次使用30 mg依诺肝素在术后长达5年的不同时间点对患者预后和成本的影响。根据比较试验结果，对美国1000例接受髋部骨折手术的患者组成的假设队列进行分析，估计其使用磺达肝癸钠或依诺肝素的概率。资源使用情况和成本（2003年美元）来自大型医疗保健数据库。结果指标为有症状VTE事件的发生率、医疗保健成本和增量成本效益比。
与依诺肝素相比，估计磺达肝癸钠在3个月时可额外预防30例VTE事件（每1000例患者），出院时节省103美元，1个月内节省290美元，3个月内节省361美元，5年内节省466美元。结果对于输入参数和假设的临床合理变化仍然稳健。
与依诺肝素相比，在广泛的假设条件下，磺达肝癸钠可改善髋部骨折手术后VTE预防的预后并节省成本。
