Hatam Nahid, Bahmei Jamshid, Keshavarz Khosro, Feiz Farnia, Sedghi Reihaneh, Borhani-Haghighi Afshin
Professor of Health Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
MSc in Health Care Services Management, Department of Health Economics, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
J Vasc Interv Neurol. 2017 Jun;9(4):6-12.
Patients with atrial fibrillation (AF) make a unique group of strokes. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are among the medications used for preventing blood coagulation. This study was carried out aiming at analyzing the cost effectiveness of LMWH versus UFH in hospitalized patients with stroke due to AF with respect to the Iranian population.
This randomized study was an economic evaluation of cost effectiveness with the help of the cross-sectional data of 2013-2015. In this study, 74 patients had undergone treatment in two groups, before being evaluated. Half of the patients were treated by LMWH, while the other half was treated by UFH. Effectiveness criterion was prevention of new stroke recurrence.
Average medical direct costs, non-medical direct costs, and indirect costs of UFH were 110375 ± 40411$, 15594 ± 11511$, and 21723 ± 19933$, respectively. Same average medical direct costs, non-medical direct costs, and indirect costs of LMWH were 99573 ± 59143$, 9016 ± 17156$, and 10385 ± 10598$, respectively. The number of prevention of new strokes due to AF in LMWH and UFH was 2 and 0, respectively. Expected effectiveness in LMWH and UFH groups was 0.56 and 0.51, respectively. Moreover, the expected costs were 26737.61$ and 30776.18$, respectively. The incremental cost-effectiveness ratio for stroke due to AF was -150, 201, 26$ per prevention of stroke recurrence (-values ≤ 0/05).
The results of the cost-effectiveness analysis of LMWH versus UFH showed that LMWH is a dominant strategy for patients with stroke due to AF in Iranian population.
房颤（AF）患者构成了一类独特的中风群体。普通肝素（UFH）和低分子量肝素（LMWH）是用于预防血液凝固的药物。本研究旨在分析LMWH与UFH相比，在伊朗房颤所致中风住院患者中的成本效益。
这项随机研究借助2013 - 2015年的横断面数据进行成本效益的经济评估。在本研究中，74例患者在接受评估前被分为两组进行治疗。一半患者接受LMWH治疗，另一半接受UFH治疗。有效性标准是预防新的中风复发。
UFH的平均医疗直接成本、非医疗直接成本和间接成本分别为110375 ± 40411美元、15594 ± 11511美元和21723 ± 19933美元。LMWH的相同平均医疗直接成本、非医疗直接成本和间接成本分别为99573 ± 59143美元、9016 ± 17156美元和10385 ± 10598美元。LMWH和UFH预防房颤所致新中风的病例数分别为2例和0例。LMWH组和UFH组的预期有效性分别为0.56和0.51。此外，预期成本分别为26737.61美元和30776.18美元。房颤所致中风的增量成本效益比为每预防一次中风复发 - 150,201,26美元（-值≤0/05）。
LMWH与UFH成本效益分析结果表明，对于伊朗房颤所致中风患者，LMWH是一种优势策略。
