Heisen Marieke, Treur Maarten J, Heemstra Harald E, Giesen Eric B W, Postma Maarten J
a Pharmerit International , Rotterdam , The Netherlands.
b Bayer B.V. , Mijdrecht , The Netherlands.
J Med Econ. 2017 Aug;20(8):813-824. doi: 10.1080/13696998.2017.1331912. Epub 2017 Jun 25.
Until recently, standard treatment of venous thromboembolism (VTE) concerned a combination of short-term low-molecular-weight heparin (LMWH) and long-term vitamin-K antagonist (VKA). Risk of bleeding and the requirement for regular anticoagulation monitoring are, however, limiting their use. Rivaroxaban is a novel oral anticoagulant associated with a significantly lower risk of major bleeds (hazard ratio = 0.54, 95% confidence interval = 0.37-0.79) compared to LMWH/VKA therapy, and does not require regular anticoagulation monitoring.
To evaluate the health economic consequences of treating acute VTE patients with rivaroxaban compared to treatment with LMWH/VKA, viewed from the Dutch societal perspective.
A life-time Markov model was populated with the findings of the EINSTEIN phase III clinical trial to analyze cost-effectiveness of rivaroxaban therapy in treatment and prevention of VTE from a Dutch societal perspective. Primary model outcomes were total and incremental quality-adjusted life years (QALYs), as well as life expectancy and costs.
Over a patient's lifetime, rivaroxaban was shown to be dominant, with health gains of 0.047 QALYs and cost savings of €304 compared to LMWH/VKA therapy. Dominance was robustly present in all sensitivity analyses. Major drivers of the differences between the two treatment arms were related to anticoagulation monitoring (medical costs, travel costs, and loss of productivity) and the occurrence of major bleeds.
Rivaroxaban treatment of patients with venous thromboembolism results in health gains and cost savings compared to LMWH/VKA therapy. This conclusion holds for the Dutch setting, both for the societal perspective, as well as the healthcare perspective.
直到最近，静脉血栓栓塞症（VTE）的标准治疗一直是短期低分子量肝素（LMWH）与长期维生素K拮抗剂（VKA）联合使用。然而，出血风险以及定期进行抗凝监测的要求限制了它们的应用。利伐沙班是一种新型口服抗凝剂，与LMWH/VKA治疗相比，其大出血风险显著降低（风险比=0.54，95%置信区间=0.37-0.79），且无需定期进行抗凝监测。
从荷兰社会角度评估与LMWH/VKA治疗相比，使用利伐沙班治疗急性VTE患者的健康经济后果。
利用EINSTEIN III期临床试验的结果构建一个终身马尔可夫模型，从荷兰社会角度分析利伐沙班治疗VTE的成本效益。模型的主要结果是总质量调整生命年（QALY）和增量质量调整生命年、预期寿命和成本。
在患者的一生中，与LMWH/VKA治疗相比，利伐沙班显示出优势，健康获益增加0.047个QALY，成本节省304欧元。在所有敏感性分析中均有力地呈现出优势。两个治疗组之间差异的主要驱动因素与抗凝监测（医疗成本、交通成本和生产力损失）以及大出血的发生有关。
与LMWH/VKA治疗相比，利伐沙班治疗静脉血栓栓塞症患者可带来健康获益和成本节省。这一结论在荷兰的情况下成立，无论是从社会角度还是医疗保健角度来看。
