直接口服抗凝剂预防全膝关节或髋关节置换术后静脉血栓栓塞症的增量净货币效益：系统评价和荟萃分析。
Incremental net monetary benefit of direct oral anticoagulants for the prevention of venous thromboembolism after total knee or hip replacement: A systematic review and meta-analysis.
机构信息
Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi, Hospital, Mahidol University, Bangkok, Thailand; Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.
出版信息
Thromb Res. 2022 Aug;216:74-83. doi: 10.1016/j.thromres.2022.06.004. Epub 2022 Jun 21.
INTRODUCTION
This meta-analysis was conducted to quantitatively pool the incremental net benefit (INB) of using direct oral anticoagulants (DOACs) for the prevention of venous thromboembolism (VTE) in patients undergoing total knee or hip replacements (TKR or THR).
MATERIALS AND METHODS
We performed a comprehensive search in several databases published before June 2021. Studies were included if they were cost-effectiveness analyses reporting cost per quality-adjusted life-year or life-year of DOACs compared to low molecular-weight heparins (LMWHs) or other anticoagulant agents for the prevention of VTE after TKR or THR. Risk of bias was also assessed using the biases in economic studies (ECOBIAS) checklist. Various monetary units were converted to purchasing power parity, adjusted to 2020 US dollars. The INBs were pooled across studies using a random-effects model, stratified by high-income countries (HICs) and low- and middle-income countries (LMICs). Heterogeneity was assessed using the I statistic.
RESULTS
A total of 49 comparisons (TKR = 25 and THR = 24) from 16 studies was included. In HICs, DOACs were cost-effective compared to LMWHs from the health care system/payer perspective for the prevention of VTE after both TKR and THR with corresponding INBs (95 % CI; I) of $231.91 ($178.71, $285.11; 0 %) and $254.99 ($159.20, $350.77; 27.79 %), respectively. In LMICs, DOACs were not cost-effective compared to LMWHs for both TKR and THR with the INBs of $94.13 (-$40.21, $228.47; 97.04 %) and $80.55 (-$157.37, $318.47; 99.78 %), respectively. No evidence of small-study effects was identified in any analyses. The cost-effectiveness of using DOACs for TKR and THR in HICs was robust across a series of sensitivity analyses.
CONCLUSIONS
DOACs were cost-effective as compared to LMWHs for VTE prophylaxis following TKR and THR surgeries in HICs. Further studies from LMICs are warranted.
简介
本荟萃分析旨在定量评估直接口服抗凝剂（DOAC）用于预防全膝关节或髋关节置换术后静脉血栓栓塞症（VTE）的增量净效益（INB）。
材料与方法
我们在几个数据库中进行了全面检索，检索时间截至 2021 年 6 月前。纳入的研究为成本效益分析，报告 DOAC 与低分子肝素（LMWH）或其他抗凝剂预防 TKR 或 THR 后 VTE 的成本每质量调整生命年或生命年。还使用经济研究偏倚（ECOBIAS）清单评估偏倚风险。各种货币单位均转换为购买力平价，并调整为 2020 年美元。采用随机效应模型对研究间的 INB 进行汇总，按高收入国家（HIC）和中低收入国家（LMIC）进行分层。使用 I 统计量评估异质性。
结果
纳入了 16 项研究的 49 项比较（TKR=25，THR=24）。在 HIC 中，DOAC 从医疗保健系统/支付者的角度来看，在预防 TKR 和 THR 后 VTE 方面，与 LMWH 相比具有成本效益，相应的 INB（95%CI；I）分别为 231.91 美元（178.71 美元，285.11 美元；0%）和 254.99 美元（159.20 美元，350.77 美元；27.79%）。在 LMIC 中，与 LMWH 相比，DOAC 在 TKR 和 THR 方面均不具有成本效益，INB 分别为 94.13 美元（-40.21 美元，228.47 美元；97.04%）和 80.55 美元（-157.37 美元，318.47 美元；99.78%）。在任何分析中均未发现小样本研究效应的证据。在一系列敏感性分析中，HIC 中使用 DOAC 进行 TKR 和 THR 的成本效益在 HIC 中是稳健的。
结论
在 HIC 中，与 LMWH 相比，DOAC 在 TKR 和 THR 手术后 VTE 预防方面具有成本效益。需要来自 LMIC 的进一步研究。
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