Pharmacy, Quimper Hospital, 14 avenue Yves Thepot, 29000, QUIMPER, France.
Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.
J Thromb Thrombolysis. 2020 Oct;50(3):642-651. doi: 10.1007/s11239-020-02047-1.
Venous thromboembolism is highly prevalent in lung cancer patients. Low molecular weight heparins are recommended for long term treatment of cancer associated venous thromboembolism. Direct oral anticoagulants are however an interesting alternative as they are administered orally and don't require monitoring. There are currently studies comparing both their efficacy and tolerance for cancer patients and more and more guidelines suggest considering direct oral anticoagulants for cancer associated venous thromboembolism treatment. The objective of this study was to evaluate the budgetary impact that direct oral anticoagulants use would have for lung cancer associated venous thromboembolism treatment and prevention in France. An economic model was made to evaluate the cost of venous thromboembolism treatment and prevention among patients with primary lung cancer in France by two strategies: current guidelines versus direct oral anticoagulants use. The model was fed with clinical and economic data extracted from the French national health information system. The analysis was conducted from the national mandatory Health insurance point of view. The time horizon of the study was the evaluation of the annual management cost. Lung cancer associated venous thromboembolism management's mean cost was estimated of 836€ per patient, that is a total cost of about 40 million euros per year at a national level. A 76% decrease of this cost can be expected with direct oral anticoagulants use. However, despite their benefits, these treatments raise new issues (medication interactions, bleeding management), and would likely not be recommended for all patients.
静脉血栓栓塞症在肺癌患者中发病率很高。低分子肝素被推荐用于癌症相关静脉血栓栓塞症的长期治疗。然而，直接口服抗凝剂是一种有趣的替代方法，因为它们是口服给药的，不需要监测。目前有研究比较了它们在癌症患者中的疗效和耐受性，越来越多的指南建议考虑直接口服抗凝剂治疗癌症相关静脉血栓栓塞症。本研究旨在评估直接口服抗凝剂在法国治疗和预防肺癌相关静脉血栓栓塞症的预算影响。建立了一个经济模型，通过两种策略（现行指南和直接口服抗凝剂的使用）来评估法国原发性肺癌患者静脉血栓栓塞症治疗和预防的成本：现行指南和直接口服抗凝剂的使用。该模型使用从法国国家健康信息系统中提取的临床和经济数据进行了填充。分析从国家强制性健康保险的角度进行。研究的时间范围是每年管理成本的评估。肺癌相关静脉血栓栓塞症管理的平均成本估计为每位患者 836 欧元，全国每年的总成本约为 4000 万欧元。直接口服抗凝剂的使用可以预期将成本降低 76%。然而，尽管这些治疗方法有其益处，但它们也带来了新的问题（药物相互作用、出血管理），可能不会推荐给所有患者。
