阿哌沙班和依诺肝素用于骨科大手术后静脉血栓预防的成本效果分析

Cost-effectiveness of apixaban compared with enoxaparin for prevention of venous thromboembolism after major orthopedic surgery in China

目的评估阿哌沙班和依诺肝素对我国全髋关节置换术或全膝关节置换术患者术后预防静脉血栓栓塞的成本效果。方法分两阶段建模,用决策树模型和马可夫模型分别进行急性期和长期模拟,经济学评价的时间跨度为16年。结果全髋关节置换术后服用阿哌沙班的患者较使用依诺肝素的患者的增量成本效果比为33021元/质量调整生命年,低于WHO推荐的支付意愿阈值(人均GDP的三倍,约115062元/QALY)。全膝关节置换术后服用阿哌沙班的患者较使用依诺肝素的患者具有成本节约优势。结论基于中国背景的经济学评价模型研究提示,对全膝关节置换术和全髋关节置换术患者,阿哌沙班较依诺肝素均具有长期应用的经济学优势。

Objective To evaluate the cost-effectiveness of apixaban compared with enoxaparin in the prevention of venous thromboembolism （ VTE ） in the Chinese patients after total hip replacement （ THR） or total knee replacement （ TKR） .Methods A two-phase modeling approach was used, with a decision tree for the acute phase and a Markov model for a longterm simulation of 16 years.Results For the patients after THR, apixaban had an incremental cost-effectiveness ratio of 33,021 yuan per quality-adjusted life year （ QALY ） when compared with enoxaparin, which was below the willingness-to-pay threshold.For the patients after TKR, apixaban dominated enoxaparin in the cost-saving.Conclusion The economic modeling study in China suggests that apixaban exhibits economic advantage over enoxaparin for the VTE prevention in the Chinese patients after THR or TKR.