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

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2.	胡大一, 孙艺红, 周自强, 等.中国人非瓣膜性心房颤动脑卒中危险因素的病例-对照研究.中华内科杂志, 2003, 42(3):157-161.
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4.	罗文苹.新型口服抗凝药在治疗血栓栓塞性疾病中的研究进展.心血管病学进展, 2015, 36(3):303-307.
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15.	马跃申, 李长平, 崔壮, 等.天津市参保脑出血患者住院费用及影响因素分析.中国慢性病预防与控制, 2012, 20(6):678-680.
16.	蒋蓉, 张安琴.两种不同给药方法治疗上消化道出血的疗效与经济学评价.解放军护理杂志, 2008, 25(9):10-11.
17.	景富春, 郭静贤, 贺继东, 等.老年急性上消化道出血患者93例住院费用分析.中国现代医药杂志, 2010, 12(6):57-59.
18.	宗欣, 孙利华.从净收益视角探讨成本-效果阈值的意义.中国药房, 2012, 23(14):1259-1261.
19.	张本, 王杨, 刘晓红, 等.生物瓣置换术后晚期血栓形成原因及应对策略分析.中国胸心血管外科临床杂志, 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. 周自强, 胡大一, 陈捷, 等.中国心房颤动现状的流行病学研究.中华内科杂志, 2004, 43(7):491-494.
2. 胡大一, 孙艺红, 周自强, 等.中国人非瓣膜性心房颤动脑卒中危险因素的病例-对照研究.中华内科杂志, 2003, 42(3):157-161.
3. 邹珺, 吴华章, 王书平, 等.凝血PT/INR快速检测服务的卫生经济学评估.卫生软科学, 2011, 25(6):367-371.
4. 罗文苹.新型口服抗凝药在治疗血栓栓塞性疾病中的研究进展.心血管病学进展, 2015, 36(3):303-307.
5. 中国老年学学会心脑血管病专业委员会.华法林临床应用中国专家共识(基层版).中华全科医学杂志, 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. 邹珺, 吴华章, 王书平, 等.凝血酶原时间(PT/INR)实验室检测项目的成本核算研究.卫生经济研究, 2011, 6:31-34.
10. 张兴文. 1.缺血性脑卒中直接医疗成本及其与预后关系研究2.血浆金属蛋白酶9对动脉粥样斑块相关的脑血管事件的预测研究.中国协和医科大学, 2008.博士毕业论文.
11. 孙沄, 黄海彬, 张宏.缺血性卒中患者直接医疗成本与影响因素分析.临床医药实践, 2013, 22(1):16-18.
12. 张婷婷.短暂性脑缺血发作的住院费用构成及其影响因素分析.大连医科大学, 2010.硕士毕业论文.
13. 姚冬芳, 王自秀, 农荧, 等.临床路径在肺栓塞患者管理中的应用.蛇志, 2013, 25(3):296-297.
14. 梅永红, 谢芬.临床护理路径在肺栓塞(中低危)患者的应用.护理研究, 2013, 11:136-137.
15. 马跃申, 李长平, 崔壮, 等.天津市参保脑出血患者住院费用及影响因素分析.中国慢性病预防与控制, 2012, 20(6):678-680.
16. 蒋蓉, 张安琴.两种不同给药方法治疗上消化道出血的疗效与经济学评价.解放军护理杂志, 2008, 25(9):10-11.
17. 景富春, 郭静贤, 贺继东, 等.老年急性上消化道出血患者93例住院费用分析.中国现代医药杂志, 2010, 12(6):57-59.
18. 宗欣, 孙利华.从净收益视角探讨成本-效果阈值的意义.中国药房, 2012, 23(14):1259-1261.
19. 张本, 王杨, 刘晓红, 等.生物瓣置换术后晚期血栓形成原因及应对策略分析.中国胸心血管外科临床杂志, 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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