Economic Evaluation of Oral Anticoagulation Therapies_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANGYun ¹ , LUXian-zhong ¹ ,  CHENWen ² ,  MENGXu ³

1. Roche Diagnostics(Shanghai) Limited Company, Shanghai 200335, P. R. China;
2. School of Public Health, Fudan University, Shanghai 200032, P. R. China;
3. Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding?author：

CHENWen, Email: wenchen@fudan.edu.cn; MENGXu, Email: mengxu100@126.com

Keywords：

Anticoagulation management; Economic evaluation; Cost effectiveness analysis

DOI：

10.7507/1007-4848.20160206

Video：

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Objective To assess the health effectiveness, cost and cost effectiveness of different oral anticoagulation (OAT) therapies in China, including warfarin plus international normalized ratio (INR) test in hospital labs (Lab test), warfarin plus patient self-management (PSM) with point of care device, and novel anticoagulant (Dabigatran) alone. Methods A Markov model containing four states (no complication, hemorrhagic event, thrombotic event and death) was developed to account for long-term cost and outcomes of warfarin/novel anticoagulant users including atrial fibrillation patients and deep venous thrombosis patients. Direct medical cost was taken into consideration, covering expenses of drugs, OAT monitoring and complication management. Both clinical and cost parameters were mainly derived from literatures. Results Compared with hospital lab test, the PSM pattern obtained a prolonged 8.48 years and 5.08 QALYs with the larger amount of cost, CNY 47 482. The incremental cost-effectiveness ratio (ICER) of PSM versus hospital lab test came to CNY 19 240 per QALY gained, lower than GDP China per capita in 2014 (CNY 46 628). And the novel anticoagulant pattern was dominated by PSM pattern due to shortened QALYs while increased cost. The sensitivity analysis demonstrated the results were not sensitive to main indicators, including utility in different health status, complication probability, and disease management cost. Conclusion PSM can generate more QALYs by reducing the risk of major thrombotic and bleeding events with acceptable incremental cost, which turns to be the most cost effective way among the 3 patterns and demonstrates promising future in OAT management.

Citation： HUANGYun, LUXian-zhong, CHENWen, MENGXu. Economic Evaluation of Oral Anticoagulation Therapies. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(9): 859-863. doi: 10.7507/1007-4848.20160206 Copy

1.	周自強, 胡大一, 陳捷, 等.中國心房顫動現狀的流行病學研究.中華內科雜志, 2004, 43(7):491-494.
2.	胡大一, 孫藝紅, 周自強, 等.中國人非瓣膜性心房顫動腦卒中危險因素的病例-對照研究.中華內科雜志, 2003, 42(3):157-161.
3.	鄒珺, 吳華章, 王書平, 等.凝血PT/INR快速檢測服務的衛生經濟學評估.衛生軟科學, 2011, 25(6):367-371.
4.	羅文蘋.新型口服抗凝藥在治療血栓栓塞性疾病中的研究進展.心血管病學進展, 2015, 36(3):303-307.
5.	中國老年學學會心腦血管病專業委員會.華法林臨床應用中國專家共識(基層版).中華全科醫學雜志, 2013, 12(10):783-787.
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11.	孫沄, 黃海彬, 張宏.缺血性卒中患者直接醫療成本與影響因素分析.臨床醫藥實踐, 2013, 22(1):16-18.
12.	張婷婷.短暫性腦缺血發作的住院費用構成及其影響因素分析.大連醫科大學, 2010.碩士畢業論文.
13.	姚冬芳, 王自秀, 農熒, 等.臨床路徑在肺栓塞患者管理中的應用.蛇志, 2013, 25(3):296-297.
14.	梅永紅, 謝芬.臨床護理路徑在肺栓塞(中低危)患者的應用.護理研究, 2013, 11:136-137.
15.	馬躍申, 李長平, 崔壯, 等.天津市參保腦出血患者住院費用及影響因素分析.中國慢性病預防與控制, 2012, 20(6):678-680.
16.	蔣蓉, 張安琴.兩種不同給藥方法治療上消化道出血的療效與經濟學評價.解放軍護理雜志, 2008, 25(9):10-11.
17.	景富春, 郭靜賢, 賀繼東, 等.老年急性上消化道出血患者93例住院費用分析.中國現代醫藥雜志, 2010, 12(6):57-59.
18.	宗欣, 孫利華.從凈收益視角探討成本-效果閾值的意義.中國藥房, 2012, 23(14):1259-1261.
19.	張本, 王楊, 劉曉紅, 等.生物瓣置換術后晚期血栓形成原因及應對策略分析.中國胸心血管外科臨床雜志, 2015, 22(4):292-297.
20.	Heneghan C, Alonso-Coello P, Garcia-Alamino JM, et al. Self-monitoring of oral anticoagulation:a systematic review and meta-analysis. Lancet, 2006, 367(9508):404-411.
21.	Christensen TD, Johnsen SP, Hjortdal VE, et al. Self-management of oral anticoagulant therapy:a systematic review and meta-analysis. Int J Cardiol, 2007, 118(1):54-61.
22.	Guilbert JJ. The world health report 2002-reducing risks, promoting healthy lifeJ. Education for health (Abingdon, England), 2003, 16(2):230.

1. 周自強, 胡大一, 陳捷, 等.中國心房顫動現狀的流行病學研究.中華內科雜志, 2004, 43(7):491-494.
2. 胡大一, 孫藝紅, 周自強, 等.中國人非瓣膜性心房顫動腦卒中危險因素的病例-對照研究.中華內科雜志, 2003, 42(3):157-161.
3. 鄒珺, 吳華章, 王書平, 等.凝血PT/INR快速檢測服務的衛生經濟學評估.衛生軟科學, 2011, 25(6):367-371.
4. 羅文蘋.新型口服抗凝藥在治療血栓栓塞性疾病中的研究進展.心血管病學進展, 2015, 36(3):303-307.
5. 中國老年學學會心腦血管病專業委員會.華法林臨床應用中國專家共識(基層版).中華全科醫學雜志, 2013, 12(10):783-787.
6. Brown A, Wells P, Jaffey J, et al. Devices for point-of-care monitoring of long term oral anticoagulation therapy:clinical and cost effectiveness technology overview number 24 Ottawa:Canadian Agency for Drugs and Technologies in Health, 2007.
7. Alonso-Coello P, Zhou Q, Guyatt G. Home-monitoring of oral anticoagulation vs. dabigatran. Thromb Haemost, 2012, 108(4):647-653.
8. Garcia-Alamino JM, Ward AM, Alonso-Coello P, et al. Self-monitoring and self-management of oral anticoagulation. Cochrane Database Syst Rev, 2010, 4:CD003839.
9. 鄒珺, 吳華章, 王書平, 等.凝血酶原時間(PT/INR)實驗室檢測項目的成本核算研究.衛生經濟研究, 2011, 6:31-34.
10. 張興文. 1.缺血性腦卒中直接醫療成本及其與預后關系研究2.血漿金屬蛋白酶9對動脈粥樣斑塊相關的腦血管事件的預測研究.中國協和醫科大學, 2008.博士畢業論文.
11. 孫沄, 黃海彬, 張宏.缺血性卒中患者直接醫療成本與影響因素分析.臨床醫藥實踐, 2013, 22(1):16-18.
12. 張婷婷.短暫性腦缺血發作的住院費用構成及其影響因素分析.大連醫科大學, 2010.碩士畢業論文.
13. 姚冬芳, 王自秀, 農熒, 等.臨床路徑在肺栓塞患者管理中的應用.蛇志, 2013, 25(3):296-297.
14. 梅永紅, 謝芬.臨床護理路徑在肺栓塞(中低危)患者的應用.護理研究, 2013, 11:136-137.
15. 馬躍申, 李長平, 崔壯, 等.天津市參保腦出血患者住院費用及影響因素分析.中國慢性病預防與控制, 2012, 20(6):678-680.
16. 蔣蓉, 張安琴.兩種不同給藥方法治療上消化道出血的療效與經濟學評價.解放軍護理雜志, 2008, 25(9):10-11.
17. 景富春, 郭靜賢, 賀繼東, 等.老年急性上消化道出血患者93例住院費用分析.中國現代醫藥雜志, 2010, 12(6):57-59.
18. 宗欣, 孫利華.從凈收益視角探討成本-效果閾值的意義.中國藥房, 2012, 23(14):1259-1261.
19. 張本, 王楊, 劉曉紅, 等.生物瓣置換術后晚期血栓形成原因及應對策略分析.中國胸心血管外科臨床雜志, 2015, 22(4):292-297.
20. Heneghan C, Alonso-Coello P, Garcia-Alamino JM, et al. Self-monitoring of oral anticoagulation:a systematic review and meta-analysis. Lancet, 2006, 367(9508):404-411.
21. Christensen TD, Johnsen SP, Hjortdal VE, et al. Self-management of oral anticoagulant therapy:a systematic review and meta-analysis. Int J Cardiol, 2007, 118(1):54-61.
22. Guilbert JJ. The world health report 2002-reducing risks, promoting healthy lifeJ. Education for health (Abingdon, England), 2003, 16(2):230.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Economic Evaluation of Oral Anticoagulation Therapies

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