肾病综合征患者预防血栓形成华法林和依诺肝素不同重叠用药方案选择的成本-效果分析

Different Warfarin and Enoxaparin Overlapping Treatment for the Prevention of Thrombosis in Nephrotic Syndrome Patients:A Cost-effectiveness Analysis

目的对肾病综合征(nephrotic syndrome,NS)患者预防静脉血栓(venous thromboembolism,VTE)、肺栓塞(pulmonary embolism,PE)形成华法林和依诺肝素不同重叠用药方案的成本-效果进行比较,为临床合理用药提供卫生经济学参考。方法采用2013至2014年广东省人民医院住院治疗NS患者的疗效和住院费用以及国家发改委定价的药品价格建立决策树模型进行成本-效果分析,并采用单因素敏感性分析检验结果的稳定性。结果华法林和依诺肝素重叠用药3天的成本为10 305.49元,成本-效果比为31 607.15;华法林和依诺肝素重叠用药4天的成本为8 849.36元,成本-效果比为20 896.46;华法林和依诺肝素重叠用药≥5天的成本为9 494.29元,成本-效果比为21 659.95。重叠用药4天相对于重叠用药≥5天的增量成本-效果比为5 600.96。重叠用药4天的成本-效果比更低而增量成本-效果比更高。敏感性分析显示即使将患者的治疗费、护理费、检查费、检验费下调20%,不同治疗方案的结果仍保持一致。结论 4天疗程的华法林和依诺肝素重叠用药方案对NS患者预防血栓形成更具成本-效果优势。但由于本研究纳入样本量较小,结果具有一定的不确定性,需更多大样本临床研究数据验证。

Objective To compare the cost-effectiveness of warfarin and enoxaparin overlapping treatment for the prevention of venous thromboembolism （VTE） or pulmonary embolism （PE） in patients with nephrotic syndrome （NS）. Methods A decision tree model was constructed. The efficacy data applied in our decision tree were from clinical data, and the cost data was based on the hospitalization cost of 103 patients with nephrotic syndrome in Guangdong Provincial People＇s Hospital from 2013 to 2014, State Development and Reform Commission pricing and literature report. The one- way sensitivity analyses was conducted to analyze the stability of test. Results In base case, the cost and cost-effective ratio of warfarin and enoxaparin overlapped treatment for 3 days were 10 305.49 yuan and 31 607.15, respectively. While those overlapped treatment for 4 days were 8 849.36 yuan and 20 896.46, overlapped treatment for 5 days and above were 9 494.29 yuan and 21 659.95, respectively. The incremental cost-effectiveness ratio of 4 days versus 5 days and above was 5 600.96. The cost-effective ratio of 4 days was lower but the incremental cost-effectiveness ratio of it was higher. The sensitivity analysis showed the test result was stable. Conclusion Cost-effectiveness analysis shows that warfarin and enoxaparin overlapping treatment for 4 days in patients with nephrotic syndrome has cost-effective advantage. Due to the limited sample size of our study, the above conclusion should be proved by more large-scale high-quality clinical studies.