利伐沙班预防全膝关节置换术后静脉血栓栓塞症的成本-效果研究

Cost-effectiveness Study of Rivaroxaban for the Prevention of Venous Thromboembolism in Patients Undergoing Total Knee Replacement

目的:评估利伐沙班预防人工全膝关节置换术后静脉血栓栓塞症的成本与效果。方法:应用决策树(急性期)和Markov模型(长期)分析与比较利伐沙班与依诺肝素预防人工全膝关节置换术后静脉血栓栓塞症的成本与效果。结果:基础病例分析结果显示利伐沙班明显占优。模型预测利伐沙班治疗组病人比依诺肝素组病人5年内可额外增加0.0019质量调整生命年(QALY),且节省242元。此外,治疗与静脉血栓栓塞症相关并发症的费用利伐沙班组为581元,依诺肝素组则为1059元。概率敏感性分析结果显示当支付意愿阈值为20000元/QALY时,约90%以上患者认为利伐沙班较依诺肝素更具成本-效果。结论:实施人工全膝关节置换术病人若术后服用利伐沙班,其预防静脉血栓栓塞症的效果优于依诺肝素。

OBJECTIVE：To evaluate the cost-effectiveness of rivaroxaban for the prevention of venous thromboembolism （VTE）following total knee replacement.METHODS：A decision tree（in acute phase）and Markov process（long-term complications）were used to analyze and compare the cost-effectiveness of rivaroxaban vs.enoxaparin for the prevention of venous thromboembolism（VTE）following total knee replacement.RESULTS：Rivaroxaban was shown to be dominant when compared with enoxaparin in both of the base-case analyses.The model predicted that rivaroxaban provided each patient an average benefit of 0.001 9 QALYs and saved 242 yuan in 5 years as compared with enoxaparin.Medical cost of rivaroxaban therapy for VTE complications was 581 yuan and that of enoxaparin was 1 059 yuan.Results of probabilistic sensitivity analysis indicated that 90% of patients believed rivaroxaban was of cost-effective advantage even at low willingness-to-pay thresholds （20 000 yuan/QALY）.CONCLUSION：Rivaroxaban is better than enoxaparin for the prevention of VTE following total knee replacement.