Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Hezar jarib Street, Isfahan, 81746-73461, Iran.
Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Daru. 2019 Dec;27(2):627-634. doi: 10.1007/s40199-019-00292-1. Epub 2019 Jul 31.
Moderate to high risk medical inpatients are at increased risk of Venous Thromboembolism (VTE). The present study aims to investigate the cost-effectiveness and cost-utility of using Enoxaparin compared to Heparin in VTE prophylaxis in medical inpatients, from Iranian payer's perspective.
Decision tree modeling technique was used to evaluate cost-effectiveness and cost-utility of the compared interventions. The main considered outcomes were Life Years Gained (LYG) for Cost-Effectiveness Analysis (CEA) and Quality-Adjusted Life Years (QALY) for Cost-Utility Analysis (CUA). Costs and consequences of the interventions were evaluated for a three-month period and reported as Incremental Cost-Effectiveness Ratios (ICERs). One-way and Probabilistic Sensitivity Analysis (PSA) were conducted to evaluate the robustness of the model due to uncertainty in the input data.
In base case scenario (i.e. public tariff), incremental cost was $10.32, and incremental QALY and incremental LYG were 0.0001 and 0.0002 per patients respectively. Base case ICERs were 60,376 USD/QALY and 71,077 USD/LYG per patient. The results of the sensitivity analysis showed the robustness of the model.
As the estimated ICER per QALY is more than three times the reported Gross Domestic Product (GDP) per capita by world bank for Iran in 2017 ($5415), the use of Enoxaparin for VTE prophylaxis in medical in patients doesn't seem to be a cost-effective intervention compared to the use of Heparin in Iran.
中高危住院患者发生静脉血栓栓塞症（VTE）的风险增加。本研究旨在从伊朗支付者的角度，调查依诺肝素与肝素相比，在预防 VTE 中的成本效益和成本效用。
决策树模型技术用于评估比较干预措施的成本效益和成本效用。主要考虑的结果是用于成本效益分析（CEA）的获得生命年（LYG）和用于成本效用分析（CUA）的质量调整生命年（QALY）。对干预措施的成本和结果进行了三个月的评估，并作为增量成本效益比（ICER）报告。进行了单因素和概率敏感性分析（PSA），以评估模型对输入数据不确定性的稳健性。
在基准情况下（即公共费率），增量成本为 10.32 美元，增量 QALY 和增量 LYG 分别为每位患者 0.0001 和 0.0002。基准情况下的 ICER 分别为每 QALY 60376 美元和每 LYG 71077 美元。敏感性分析的结果表明了模型的稳健性。
由于估计的每 QALY 的 ICER 超过了世界银行 2017 年报告的伊朗人均国内生产总值（GDP）的三倍（5415 美元），因此与肝素相比，依诺肝素在预防中高危住院患者 VTE 中的使用在伊朗似乎不是一种具有成本效益的干预措施。
