Department of Outcomes Research, New Mexico Heart Institute, University of New Mexico, Albuquerque, NM 87102, USA.
J Med Econ. 2012;15(4):611-22. doi: 10.3111/13696998.2012.667026. Epub 2012 Feb 28.
Venous thromboembolism (VTE) incurs considerable socioeconomic costs, partly owing to the fact that the treatment and prevention of VTE via effective thromboprophylaxis remains suboptimal in the inpatient and outpatient settings of many healthcare systems. A number of organizations-including the National Quality Forum, The Joint Commission, and the Centers for Medicare and Medicaid Services-have established measures to assess and reduce the healthcare burden of VTE. These improvement strategies focus on increasing the use of thromboprophylaxis, implementing existing guidelines, and improving awareness.
Based on clinical trial results, the oral anti-coagulants rivaroxaban, apixaban, and dabigatran etexilate have been approved in many countries for the prevention of VTE in patients after elective hip or knee replacement surgery. Recently, dabigatran etexilate and rivaroxaban have also been approved in the US for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. In addition, rivaroxaban is currently the only newer anti-coagulant that has been approved in Europe for the treatment of deep vein thrombosis and for the long-term prevention of recurrent VTE. These oral anti-coagulants have several advantages over established anti-coagulants, including no need for routine coagulation monitoring and only minimal food and drug interactions. These characteristics, together with convenient oral administration, may improve adherence and quality of life for patients, which could result in reductions in the rate of VTE.
These three oral agents have several advantages over established anti-coagulants and could, therefore, address the unmet needs of patients, physicians, and healthcare systems, with the potential to reduce the burden of anti-coagulant management and the occurrence of VTE.
静脉血栓栓塞症（VTE）会带来相当大的社会经济成本，部分原因是在许多医疗保健系统的住院和门诊环境中，通过有效的血栓预防来治疗和预防 VTE 的效果仍不尽如人意。一些组织——包括国家质量论坛、联合委员会和医疗保险和医疗补助服务中心——已经制定了评估和降低 VTE 医疗负担的措施。这些改进策略侧重于增加血栓预防的使用、实施现有指南和提高认识。
基于临床试验结果，在许多国家，口服抗凝剂利伐沙班、阿哌沙班和达比加群酯已获准用于预防择期髋关节或膝关节置换术后患者的 VTE。最近，达比加群酯和利伐沙班也在美国获准用于预防非瓣膜性心房颤动患者的中风和全身性栓塞。此外，利伐沙班是目前唯一一种在欧洲获准用于治疗深静脉血栓形成和长期预防复发性 VTE 的新型抗凝剂。与已确立的抗凝剂相比，这些口服抗凝剂具有几个优势，包括无需常规凝血监测和仅最小的食物和药物相互作用。这些特性，加上方便的口服给药，可能会提高患者的依从性和生活质量，从而降低 VTE 的发生率。
这三种口服药物与已确立的抗凝剂相比具有几个优势，因此可以满足患者、医生和医疗保健系统的未满足需求，有可能减轻抗凝剂管理的负担并降低 VTE 的发生。
