Nafamostat mesylate and unfractionated heparin for continuous renal replacement therapy anticoagulation: a cost minimization analysis based on decision tree model_Chinese Journal of Evidence-Based Medicine

Authors：

AN Qi , JING Tianyu , ZHA Jingkai , ZOU Jie ,  XU Wei

International Medical Business School, China Pharmaceutical University, Nanjing 211198, P. R. China;

Corresponding?author：

XU Wei, Email: xu2005wei@126.com

Keywords：

CRRT; Nafamostat mesylate; Unfractionated heparin; Decision tree model; Cost minimization analysis

DOI：

10.7507/1672-2531.202208085

Video：

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Objective To evaluate the economics of nafamostat mesylate compared with unfractionated heparin for continuous renal replacement therapy anticoagulation. Methods A decision tree model was constructed to calculate the cost difference between the two anticoagulation methods. Survival analysis data comes from retrospective literature in Asian countries. The cost data comes from procurement data and the prices of medical and health services in some regions. A 72-hour scenario analysis is performed and a sensitivity analysis is performed on key parameters. Results The basic analysis results showed that compared with the unfractionated heparin group, the total cost difference of nafamostat in the 144-hour CRRT treatment was 5 350.34 yuan, and the unfractionated heparin was more economical. In the 72-hour scenario analysis, unfractionated heparin is also more economical. Univariate sensitivity analysis showed that the cost of single-use hemodialysis filters and supporting pipelines and the cost of plasma antithrombin Ⅲ activity (AT-Ⅲ) measurement had a greater impact on the change of the cost difference. The results of probability sensitivity analysis show that the model structure is stable and robust. When the unit price of nafamostat is about 110.82 yuan/piece, the cost of nafamostat and unfractionated heparin in 144-hour CRRT treatment is both 19 185.37 yuan, and the cost difference is 0.Conclusion When the unit price of nafamostat mesylate drops to a sufficiently low level, it could have an advantageous health economy.

Citation： AN Qi, JING Tianyu, ZHA Jingkai, ZOU Jie, XU Wei. Nafamostat mesylate and unfractionated heparin for continuous renal replacement therapy anticoagulation: a cost minimization analysis based on decision tree model. Chinese Journal of Evidence-Based Medicine, 2023, 23(2): 139-146. doi: 10.7507/1672-2531.202208085 Copy

1.	潘晨亮, 趙晶, 張博, 等. 連續腎臟替代治療在心血管危重癥患者中的應用研究進展. 中國心血管病研究, 2022, 20(5): 466-470.
2.	陳惠德. 連續腎臟替代治療在危重癥患者中的應用. 醫師進修雜志, 2003, (19): 5-7.
3.	周輝. 探討SOFA評分與RIFLE分期在連續性腎臟替代治療時機選擇中的價值. 南昌: 南昌大學, 2015.
4.	潘旭東, 趙宏磊, 劉寧寧, 等. 連續性腎臟替代治療在急性StanfordA型主動脈夾層術后急性腎損傷中的應用. 心肺血管病雜志, 2016, 35(3): 189-192,199.
5.	方志成, 周昌娥, 鄭翔, 等. 不同容量連續性腎臟替代治療嚴重腹腔感染對比研究. 陜西醫學雜志, 2011, 40(3): 302-304.
6.	董書婭, 楊金芳, 佘麗平, 等. 兩種抗凝方法在消化道出血患者行連續性腎替代治療中的應用. 吉林醫學, 2015, 36(3): 518-519.
7.	張穎釩. 基于APACHEⅡ聯合動態SOFA評分的分級監測在CRRT患者中的應用. 遵義: 遵義醫學院, 2016.
8.	李果. 武漢市連續性腎替代治療應用現況及成本測算研究. 武漢: 武漢大學, 2018.
9.	Hwang SD, Hyun YK, Moon SJ, et al. Nafamostat mesilate for anticoagulation in continuous renal replacement therapy. Int J Artif Organs, 2013, 36(3): 208-216.
10.	李敏俠, 李月紅, 蔡廣研. 連續性腎臟替代治療抗凝方式的選擇. 臨床內科雜志, 2017, 34(4): 227-229.
11.	吳克. 人抗凝血酶Ⅲ的特性與應用. 國外醫學. 輸血及血液學分冊, 1996, (1): 28-31.
12.	何艷. 血栓前體蛋白和抗凝血酶-Ⅲ在糖尿病微血管病變患者中的檢測及臨床意義. 南充: 川北醫學院, 2013.
13.	Etchells E, McLeod RS, Geerts W, et al. Economic analysis of low-dose heparin vs the low-molecular-weight heparin enoxaparin for prevention of venous thromboembolism after colorectal surgery. Arch Intern Med, 1999, 159(11): 1221-1228.
14.	Lopes DG, Tamayo A, Schipp B, et al. Cost-effectiveness of edoxaban vs low-molecular-weight heparin and warfarin for cancer-associated thrombosis in Brazil. Thromb Res, 2020, 196: 4-10.
15.	Lim JY, Kim JB, Choo SJ, et al. Anticoagulation during extracorporeal membrane oxygenation; nafamostat mesilate versus heparin. Ann Thorac Surg, 2016, 102(2): 534-539.
16.	Makino S, Egi M, Kita H, et al. Comparison of nafamostat mesilate and unfractionated heparin as anticoagulants during continuous renal replacement therapy. Int J Artif Organs, 2016, 39(1): 16-21.
17.	Baek NN, Jang HR, Huh W, et al. The role of nafamostat mesylate in continuous renal replacement therapy among patients at high risk of bleeding. Ren Fail, 2012, 34(3): 279-285.
18.	Choi JY, Kang YJ, Jang HM, et al. Nafamostat mesilate as an anticoagulant during continuous renal replacement therapy in patients with high bleeding risk: a randomized clinical trial. Medicine (Baltimore), 2015, 94(52): e2392.
19.	Han W, San Bok J, Cho HJ, et al. Single-center experience of extracorporeal membrane oxygenation mainly anticoagulated with nafamostat mesilate. J Thorac Dis, 2019, 11(7): 2861-2867.
20.	Malhotra AK, Goldberg SR, McLay L, et al. DVT surveillance program in the ICU: analysis of cost-effectiveness. PLoS One, 2014, 9(9): e106793.
21.	Douketis JD, Kearon C, Bates S, et al. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA, 1998, 279(6): 458-462.
22.	Reeves JH, Cumming AR, Gallagher L, et al. A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration. Crit Care Med, 1999, 27(10): 2224-2228.
23.	國家統計局. 全國年度統計公報, 2022-2-28. Available at: http://www.stats.gov.cn/.
24.	藥智網. 甲磺酸萘莫司他說明書. Available at: https://www.yaozh.com/.
25.	北村伸哉, 張凌. 甲磺酸萘莫司他在連續性腎臟替代治療中的抗凝應用. 華西醫學, 2018, 33(7): 801-805.
26.	藥智網. 萘莫司他價格. Available at: https://www.yaozh.com/.
27.	李元忠, 安麗麗. 連續性腎替代治療: 如何做到適宜的抗凝治療. 中華重癥醫學電子雜志(網絡版), 2017, 3(3): 214-219.
28.	上海市衛生健康委員會. 醫療服務項目價格(2017版)公示. Available at: https://wsjkw.sh.gov.cn/wsj/download/jgb_2017.pdf.
29.	珠海市醫療保障局. 關于珠海市部分現行醫療服務價格文件及目錄的通告, 2019-04-28. Available at: http://www.zhuhai.gov.cn/ylbzj/gkmlpt/content/1/1885/post_1885673.html#6136.
30.	遼寧省醫療保障局. 關于制定遼寧省公立醫療機構醫療服務項目最高限價及有關問題的通知, 2019-12-30. Available at: http://ybj.ln.gov.cn/zwgk/zcwj/zcwj/202005/t20200512_3851110.html.
31.	江西省醫療保障局. 關于《江西省醫療服務價格項目目錄(2021版) (征求意見稿)》的公示, 2021-05-25. Available at: http://ybj.jiangxi.gov.cn/art/2021/5/25/art_28422_3375262.html.
32.	李志方, 黃麗霞, 陳名桂, 等. CRRT靜脈壺堵塞時緊急回血通路的搭建及應用. 當代護士(上旬刊), 2021, 28(11): 135-136.
33.	國家衛健委, 國家發改委. 關于調整公民臨床用血收費標準的通知. Available at: http://www.gov.cn/gongbao/content/2006/content_253027.htm.
34.	黃雪芳, 孔耀中, 肖觀清, 等. 血液凈化中心不同透析液供應方式的成本對比. 現代醫院, 2017, 17(6): 823-825.
35.	鏡湖區經濟和信息化局. 鏡湖區經信局關于采購疫情防控物資的詢價結果公示. Available at: https://www.whjhq.gov.cn/xwdt/gggs/18354380.html, 2022.
36.	中國政府采購網. 醫用手套采購(二次)中標公告, 2022-04-25. Available at: https://www.tianyancha.com/bid/bc560e69347f4944badac2d475028a2b.
37.	泰興市人民醫院. 泰興市人民醫院一次性手術衣中標公告, 2022-01-20. Available at: https://www.tianyancha.com/bid/50542b86482b456a9363e7c9dc8dbb15.
38.	蔡榮根, 曹利明, 李理, 等. 時空奇異性和宇宙監督假設. 中國科學: 物理學力學天文學: 2022, 9: 1-52. Available at: http://kns.cnki.net/kcms/detail/11.5848.N.20220927.1358.002.html.
39.	寶雞市陳倉區地方志編纂委員會. 寶雞市陳倉區志(1990~2010). 陜西三秦出版社:陜西地方志叢書, 2018: 1170.
40.	樊豐夷, 吳欣, 張春, 等. 國產透析液過濾器與進口透析液過濾器性能對比. 中國血液凈化, 2020, 19(8): 559-561.

1. 潘晨亮, 趙晶, 張博, 等. 連續腎臟替代治療在心血管危重癥患者中的應用研究進展. 中國心血管病研究, 2022, 20(5): 466-470.
2. 陳惠德. 連續腎臟替代治療在危重癥患者中的應用. 醫師進修雜志, 2003, (19): 5-7.
3. 周輝. 探討SOFA評分與RIFLE分期在連續性腎臟替代治療時機選擇中的價值. 南昌: 南昌大學, 2015.
4. 潘旭東, 趙宏磊, 劉寧寧, 等. 連續性腎臟替代治療在急性StanfordA型主動脈夾層術后急性腎損傷中的應用. 心肺血管病雜志, 2016, 35(3): 189-192,199.
5. 方志成, 周昌娥, 鄭翔, 等. 不同容量連續性腎臟替代治療嚴重腹腔感染對比研究. 陜西醫學雜志, 2011, 40(3): 302-304.
6. 董書婭, 楊金芳, 佘麗平, 等. 兩種抗凝方法在消化道出血患者行連續性腎替代治療中的應用. 吉林醫學, 2015, 36(3): 518-519.
7. 張穎釩. 基于APACHEⅡ聯合動態SOFA評分的分級監測在CRRT患者中的應用. 遵義: 遵義醫學院, 2016.
8. 李果. 武漢市連續性腎替代治療應用現況及成本測算研究. 武漢: 武漢大學, 2018.
9. Hwang SD, Hyun YK, Moon SJ, et al. Nafamostat mesilate for anticoagulation in continuous renal replacement therapy. Int J Artif Organs, 2013, 36(3): 208-216.
10. 李敏俠, 李月紅, 蔡廣研. 連續性腎臟替代治療抗凝方式的選擇. 臨床內科雜志, 2017, 34(4): 227-229.
11. 吳克. 人抗凝血酶Ⅲ的特性與應用. 國外醫學. 輸血及血液學分冊, 1996, (1): 28-31.
12. 何艷. 血栓前體蛋白和抗凝血酶-Ⅲ在糖尿病微血管病變患者中的檢測及臨床意義. 南充: 川北醫學院, 2013.
13. Etchells E, McLeod RS, Geerts W, et al. Economic analysis of low-dose heparin vs the low-molecular-weight heparin enoxaparin for prevention of venous thromboembolism after colorectal surgery. Arch Intern Med, 1999, 159(11): 1221-1228.
14. Lopes DG, Tamayo A, Schipp B, et al. Cost-effectiveness of edoxaban vs low-molecular-weight heparin and warfarin for cancer-associated thrombosis in Brazil. Thromb Res, 2020, 196: 4-10.
15. Lim JY, Kim JB, Choo SJ, et al. Anticoagulation during extracorporeal membrane oxygenation; nafamostat mesilate versus heparin. Ann Thorac Surg, 2016, 102(2): 534-539.
16. Makino S, Egi M, Kita H, et al. Comparison of nafamostat mesilate and unfractionated heparin as anticoagulants during continuous renal replacement therapy. Int J Artif Organs, 2016, 39(1): 16-21.
17. Baek NN, Jang HR, Huh W, et al. The role of nafamostat mesylate in continuous renal replacement therapy among patients at high risk of bleeding. Ren Fail, 2012, 34(3): 279-285.
18. Choi JY, Kang YJ, Jang HM, et al. Nafamostat mesilate as an anticoagulant during continuous renal replacement therapy in patients with high bleeding risk: a randomized clinical trial. Medicine (Baltimore), 2015, 94(52): e2392.
19. Han W, San Bok J, Cho HJ, et al. Single-center experience of extracorporeal membrane oxygenation mainly anticoagulated with nafamostat mesilate. J Thorac Dis, 2019, 11(7): 2861-2867.
20. Malhotra AK, Goldberg SR, McLay L, et al. DVT surveillance program in the ICU: analysis of cost-effectiveness. PLoS One, 2014, 9(9): e106793.
21. Douketis JD, Kearon C, Bates S, et al. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA, 1998, 279(6): 458-462.
22. Reeves JH, Cumming AR, Gallagher L, et al. A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration. Crit Care Med, 1999, 27(10): 2224-2228.
23. 國家統計局. 全國年度統計公報, 2022-2-28. Available at: http://www.stats.gov.cn/.
24. 藥智網. 甲磺酸萘莫司他說明書. Available at: https://www.yaozh.com/.
25. 北村伸哉, 張凌. 甲磺酸萘莫司他在連續性腎臟替代治療中的抗凝應用. 華西醫學, 2018, 33(7): 801-805.
26. 藥智網. 萘莫司他價格. Available at: https://www.yaozh.com/.
27. 李元忠, 安麗麗. 連續性腎替代治療: 如何做到適宜的抗凝治療. 中華重癥醫學電子雜志(網絡版), 2017, 3(3): 214-219.
28. 上海市衛生健康委員會. 醫療服務項目價格(2017版)公示. Available at: https://wsjkw.sh.gov.cn/wsj/download/jgb_2017.pdf.
29. 珠海市醫療保障局. 關于珠海市部分現行醫療服務價格文件及目錄的通告, 2019-04-28. Available at: http://www.zhuhai.gov.cn/ylbzj/gkmlpt/content/1/1885/post_1885673.html#6136.
30. 遼寧省醫療保障局. 關于制定遼寧省公立醫療機構醫療服務項目最高限價及有關問題的通知, 2019-12-30. Available at: http://ybj.ln.gov.cn/zwgk/zcwj/zcwj/202005/t20200512_3851110.html.
31. 江西省醫療保障局. 關于《江西省醫療服務價格項目目錄(2021版) (征求意見稿)》的公示, 2021-05-25. Available at: http://ybj.jiangxi.gov.cn/art/2021/5/25/art_28422_3375262.html.
32. 李志方, 黃麗霞, 陳名桂, 等. CRRT靜脈壺堵塞時緊急回血通路的搭建及應用. 當代護士(上旬刊), 2021, 28(11): 135-136.
33. 國家衛健委, 國家發改委. 關于調整公民臨床用血收費標準的通知. Available at: http://www.gov.cn/gongbao/content/2006/content_253027.htm.
34. 黃雪芳, 孔耀中, 肖觀清, 等. 血液凈化中心不同透析液供應方式的成本對比. 現代醫院, 2017, 17(6): 823-825.
35. 鏡湖區經濟和信息化局. 鏡湖區經信局關于采購疫情防控物資的詢價結果公示. Available at: https://www.whjhq.gov.cn/xwdt/gggs/18354380.html, 2022.
36. 中國政府采購網. 醫用手套采購(二次)中標公告, 2022-04-25. Available at: https://www.tianyancha.com/bid/bc560e69347f4944badac2d475028a2b.
37. 泰興市人民醫院. 泰興市人民醫院一次性手術衣中標公告, 2022-01-20. Available at: https://www.tianyancha.com/bid/50542b86482b456a9363e7c9dc8dbb15.
38. 蔡榮根, 曹利明, 李理, 等. 時空奇異性和宇宙監督假設. 中國科學: 物理學力學天文學: 2022, 9: 1-52. Available at: http://kns.cnki.net/kcms/detail/11.5848.N.20220927.1358.002.html.
39. 寶雞市陳倉區地方志編纂委員會. 寶雞市陳倉區志(1990~2010). 陜西三秦出版社:陜西地方志叢書, 2018: 1170.
40. 樊豐夷, 吳欣, 張春, 等. 國產透析液過濾器與進口透析液過濾器性能對比. 中國血液凈化, 2020, 19(8): 559-561.

Chinese Journal of Evidence-Based Medicine

Nafamostat mesylate and unfractionated heparin for continuous renal replacement therapy anticoagulation: a cost minimization analysis based on decision tree model

Abstract Full text Figures/Tables Video References Cited by

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