Permsuwan Unchalee, Chaiyakunapruk Nathorn, Nathisuwan Surakit, Sukonthasarn Apichard
Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
School of Pharmacy, Monash University Malaysia, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Population Health, University of Queensland, Brisbane, Australia; School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
Heart Lung Circ. 2015 Sep;24(9):860-8. doi: 10.1016/j.hlc.2015.02.018. Epub 2015 Mar 14.
Non-ST elevation acute coronary syndrome (NSTE-ACS) imposes a significant health and economic burden on a society. Anticoagulants are recommended as standard therapy by various clinical practice guidelines. Fondaparinux was introduced and evaluated in a number of large randomised, controlled trials. This study therefore aimed to determine the cost-effectiveness of fondaparinux versus enoxaparin in the treatment of NSTE-ACS in Thailand.
A two-part construct model comprising a one-year decision tree and a Markov model was developed to capture short and long-term costs and outcomes from the perspective of provider and society. Effectiveness data were derived from OASIS-5 trial while bleeding rates were derived from the Thai Acute Coronary Syndrome Registry (TACSR). Costs data were based on a Thai database and presented in the year of 2013. Both costs and outcomes were discounted by 3% annually. A series of sensitivity analyses were performed.
The results showed that compared with enoxaparin, fondaparinux was a cost-saving strategy (lower cost with slightly higher effectiveness). Cost of revascularisation with major bleeding had a greater impact on the amount of cost saved both from societal and provider perspectives. With a threshold of 160,000 THB ((4,857.3 USD) per QALY in Thailand, fondaparinux was about 99% more cost-effective compared with enoxaparin.
Fondaparinux should be considered as a cost-effective alternative when compared to enoxaparin for NSTE-ACS based on Thailand's context, especially in the era of limited healthcare resources.
非ST段抬高型急性冠状动脉综合征（NSTE-ACS）给社会带来了巨大的健康和经济负担。各种临床实践指南均推荐使用抗凝剂作为标准治疗方法。磺达肝癸钠已在多项大型随机对照试验中被引入并进行了评估。因此，本研究旨在确定在泰国治疗NSTE-ACS时，磺达肝癸钠与依诺肝素相比的成本效益。
构建了一个由一年期决策树和马尔可夫模型组成的两部分模型，以从医疗机构和社会的角度捕捉短期和长期成本及结果。有效性数据来自OASIS-5试验，而出血率数据来自泰国急性冠状动脉综合征注册研究（TACSR）。成本数据基于泰国数据库，并以2013年的数据呈现。成本和结果均按每年3%进行贴现。进行了一系列敏感性分析。
结果表明，与依诺肝素相比，磺达肝癸钠是一种节省成本的策略（成本更低，有效性略高）。伴有大出血的血运重建成本对从社会和医疗机构角度节省的成本金额有更大影响。在泰国，每质量调整生命年（QALY）的成本阈值为160,000泰铢（4,857.3美元），与依诺肝素相比，磺达肝癸钠的成本效益高出约99%。
基于泰国的情况，尤其是在医疗资源有限的时代，与依诺肝素相比，磺达肝癸钠应被视为治疗NSTE-ACS的一种具有成本效益的替代方案。
