Different Warfarin and Enoxaparin Overlapping Treatment for the Prevention of Thrombosis in Nephrotic Syndrome Patients: A Cost-effectiveness Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 HUANGBi-yu ¹ , YANGMin ¹ , LIUXiao-qi ¹ , LIUShuang-xin ² , MAIYin-hua ³ ,  LAOHai-yan ¹

1. Department of Pharmacy, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China;
2. Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China;
3. School of Pharmaceutical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China;

Corresponding?author：

LAOHai-yan, Email: laohaiyan1208@vip.sina.com

Keywords：

Nephrotic syndrome; Warfarin; Enoxaparin; Cost-effectiveness analysis; Decision tree

DOI：

10.7507/1672-2531.20160117

Video：

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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 10305.49 yuan and 31607.15, respectively. While those overlapped treatment for 4 days were 8849.36 yuan and 20896.46, overlapped treatment for 5 days and above were 9494.29 yuan and 21659.95, respectively. The incremental cost-effectiveness ratio of 4 days versus 5 days and above was 5600.96. 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.

Citation： HUANGBi-yu, YANGMin, LIUXiao-qi, LIUShuang-xin, MAIYin-hua, LAOHai-yan. Different Warfarin and Enoxaparin Overlapping Treatment for the Prevention of Thrombosis in Nephrotic Syndrome Patients: A Cost-effectiveness Analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(7): 754-759. doi: 10.7507/1672-2531.20160117 Copy

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16.	宋紅雨, 李金炎, 云少民. 低分子肝素治療腎病綜合征的療效分析. 中國醫療前沿, 2012, 7(4):42-43.
17.	許建國. 低分子肝素在腎病綜合征中應用觀察. 中國現代醫藥雜志, 2007, 9(4):91-92.
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19.	劉俊, 欒家杰, 徐文科, 等. 中國漢族人群基于臨床特征和基因型華法林個體化給藥模型的研究. 中國臨床藥理學與治療學, 2014, 19(3):284-289.
20.	汪愛民. 華法林的應用研究進展. 實用心腦肺血管病雜志, 2011, 19(9):1619-1620.
21.	《中國藥物經濟學評價指南》課題組. 中國藥物經濟學評價指南(2011版). 中國藥物經濟學, 2011, (3):7-48.

1. 任高. 腎病綜合征. 北京:人民衛生出版社, 1996, 4:21-22.
2. 胡小紅, 錢一欣, 陶煜, 等. 10年前后原發性腎小球病的臨床和病理分型特點分析. 臨床腎臟病雜志, 2012, 12(12):545-548.
3. You JHS. Is INR between 2.0 and 3.0 the optimal level for Chinese patients on warfarin therapy for moderate-intensity anticoagulation?. British J of Clin Pharm, 2005, 5(59):582-587.
4. Suzuki S, Yamashita T, Kato T, et al. Incidence of major bleeding complication of warfarin therapy in Japanese patients with atrial fibrillation. Circ J, 2007, 71(5):761-765.
5. 中華醫學會心血管病學分會、中國老年學學會心腦血管病專業委員會. 華法林抗凝治療的中國專家共識. 中華內科雜志, 2013, 52(1):76-82.
6. 中國成人腎病綜合征免疫抑制治療專家組. 中國成人腎病綜合征免疫抑制治療專家共識. 中華腎臟病雜志, 2014, 30(6):467-474.
7. 唐克菲, 王建文. 腎病綜合征合并靜脈血栓臨床特征及相關因素分析. 醫藥信息, 2011, 24(3):1202-1203.
8. 李納琦, 薛繼強. 原發性腎病綜合征高凝狀態相關因素之間的關系. 哈爾濱醫科大學學報, 2006, 40(2):159-161.
9. 王海燕. 腎臟病學. 第2版. 北京:人民衛生出版社, 1996:494, 502.
10. Medjeral-Thomas N, Ziaj S, Condon M. Retrospective analysis of a novel regimen for the prevention of venous thromboembolism in nephrotic syndrome. Clin J Am Soc Nephrol, 2014, 9(3):478-483.
11. 夏洪. 低分子肝素鈣治療原發性腎病綜合征伴高凝狀態的療效觀察. 中國藥物經濟學, 2013, 8(3):121-122.
12. 張樂文. 低分子肝素鈣輔助治療原發性腎病綜合征35例療效觀察. 臨床合理用藥雜志, 2010, 3(4):22-23.
13. 謝志安. 低分子肝素治療原發性腎病綜合征療效觀察. 臨床合理用藥雜志, 2010, 3(8):44-45.
14. Kerlin BA, Ayoob R, Smoyer WE.Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease. Clin J Am Soc Nephrol, 2012, 7(3):513-520.
15. Glassock RJ. Prophylactic anticoagulation in nephrotic syndrome:a clinical conundrum. J Am Soc Nephrol, 2007, 18(8):2221-2225.
16. 宋紅雨, 李金炎, 云少民. 低分子肝素治療腎病綜合征的療效分析. 中國醫療前沿, 2012, 7(4):42-43.
17. 許建國. 低分子肝素在腎病綜合征中應用觀察. 中國現代醫藥雜志, 2007, 9(4):91-92.
18. Caprini JA, Arcelus J, Sehgal LR. The use of low molecular weight heparins for the prevention of postoperative venous thromboembolism in general surgery. A survey of practice in the United States. Int Angiol, 2002, 21(1):78-85.
19. 劉俊, 欒家杰, 徐文科, 等. 中國漢族人群基于臨床特征和基因型華法林個體化給藥模型的研究. 中國臨床藥理學與治療學, 2014, 19(3):284-289.
20. 汪愛民. 華法林的應用研究進展. 實用心腦肺血管病雜志, 2011, 19(9):1619-1620.
21. 《中國藥物經濟學評價指南》課題組. 中國藥物經濟學評價指南(2011版). 中國藥物經濟學, 2011, (3):7-48.

Chinese Journal of Evidence-Based Medicine

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

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