希腊利伐沙班治疗深静脉血栓和肺栓塞的成本效益分析。
Cost-Effectiveness Analysis of Rivaroxaban for Treatment of Deep Vein Thrombosis and Pulmonary Embolism in Greece.
机构信息
Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece.
The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
出版信息
Clin Drug Investig. 2017 Sep;37(9):833-844. doi: 10.1007/s40261-017-0540-1.
BACKGROUND AND OBJECTIVE
Venous thromboembolism (VTE), comprising deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a major healthcare concern that results in substantial morbidity and mortality with great economic burden for healthcare systems. Hence, the need for effective and efficient treatment of patients with VTE is important for both clinical and economic reasons. The objective of this study was to evaluate the cost effectiveness of rivaroxaban compared to standard of care (SoC) with enoxaparin followed by dose-adjusted vitamin-K antagonists for the treatment of DVT and PE in Greece.
METHODS
An existing Markov model was locally adapted from a third-party payer perspective to reflect the management and complications of DVT and PE in the course of 3-month cycles, up to death. The clinical inputs and utility values were extracted from published studies. Direct medical costs, obtained from local resources, were incorporated in the model and refer to year 2017. Both costs and outcomes were discounted at 3.5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained was calculated. Probabilistic sensitivity analysis (PSA) was carried out to deal with uncertainty.
RESULTS
The base-case analysis showed that rivaroxaban in 3- and 6-month treatment duration for DVT and PE, respectively, as this is the common clinical practice in Greece, was associated with a 0.02 and 0.01 increment in QALYs compared to SoC, respectively. Rivaroxaban was associated with a reduced total cost in DVT (€85) but with an additional total cost in PE (€2) compared to SoC. Therefore, rivaroxaban was a dominant (less costly, more effective) and cost-effective (ICER: €177) alternative over SoC for the management of DVT and PE, respectively. PSA revealed that the probability of rivaroxaban being cost effective at a threshold of €34,000 per QALY gained was 99% and 81% for DVT and PE, respectively.
CONCLUSION
Rivaroxaban may represent a cost-effective option relative to SoC for the management of DVT and PE in Greece.
背景与目的
静脉血栓栓塞症（VTE）包括深静脉血栓形成（DVT）和肺栓塞（PE），是一个主要的医疗保健关注点，会导致大量的发病率和死亡率，并给医疗系统带来巨大的经济负担。因此，对于 VTE 患者的有效和高效治疗，无论从临床还是经济角度来看，都非常重要。本研究的目的是评估利伐沙班相对于标准治疗（SoC）与依诺肝素随后剂量调整的维生素 K 拮抗剂在希腊治疗 DVT 和 PE 的成本效益。
方法
从第三方支付者的角度出发，对现有的 Markov 模型进行了局部调整，以反映 3 个月周期内 DVT 和 PE 的管理和并发症，直至死亡。临床输入和效用值从已发表的研究中提取。直接医疗成本从当地资源中获得，并参考 2017 年的数据。所有成本和结果均以 3.5%的贴现率进行贴现。每获得一个质量调整生命年（QALY）的增量成本效益比（ICER）进行计算。采用概率敏感性分析（PSA）来处理不确定性。
结果
基础分析表明，在希腊，利伐沙班治疗 DVT 的 3 个月和 6 个月的疗程，分别与 SoC 相比，分别增加了 0.02 和 0.01 的 QALY。与 SoC 相比，利伐沙班在 DVT 治疗中降低了总费用（85 欧元），但在 PE 中增加了总费用（2 欧元）。因此，利伐沙班在 DVT 和 PE 的管理中，分别作为 SoC 的替代方案，具有更低的成本和更高的疗效（ICER：分别为 177 欧元）。PSA 显示，利伐沙班在 DVT 和 PE 的每 QALY 获益 34000 欧元的阈值下具有成本效益的概率分别为 99%和 81%。
结论
在希腊，利伐沙班可能是一种相对于 SoC 治疗 DVT 和 PE 的具有成本效益的选择。
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