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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19.	刘俊, 栾家杰, 徐文科, 等. 中国汉族人群基于临床特征和基因型华法林个体化给药模型的研究. 中国临床药理学与治疗学, 2014, 19(3):284-289.
20.	汪爱民. 华法林的应用研究进展. 实用心脑肺血管病杂志, 2011, 19(9):1619-1620.
21.	《中国药物经济学评价指南》课题组. 中国药物经济学评价指南(2011版). 中国药物经济学, 2011, (3):7-48.

1. 任高. 肾病综合征. 北京:人民卫生出版社, 1996, 4:21-22.
2. 胡小红, 钱一欣, 陶煜, 等. 10年前后原发性肾小球病的临床和病理分型特点分析. 临床肾脏病杂志, 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. 中华医学会心血管病学分会、中国老年学学会心脑血管病专业委员会. 华法林抗凝治疗的中国专家共识. 中华内科杂志, 2013, 52(1):76-82.
6. 中国成人肾病综合征免疫抑制治疗专家组. 中国成人肾病综合征免疫抑制治疗专家共识. 中华肾脏病杂志, 2014, 30(6):467-474.
7. 唐克菲, 王建文. 肾病综合征合并静脉血栓临床特征及相关因素分析. 医药信息, 2011, 24(3):1202-1203.
8. 李纳琦, 薛继强. 原发性肾病综合征高凝状态相关因素之间的关系. 哈尔滨医科大学学报, 2006, 40(2):159-161.
9. 王海燕. 肾脏病学. 第2版. 北京:人民卫生出版社, 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. 低分子肝素钙治疗原发性肾病综合征伴高凝状态的疗效观察. 中国药物经济学, 2013, 8(3):121-122.
12. 张乐文. 低分子肝素钙辅助治疗原发性肾病综合征35例疗效观察. 临床合理用药杂志, 2010, 3(4):22-23.
13. 谢志安. 低分子肝素治疗原发性肾病综合征疗效观察. 临床合理用药杂志, 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. 宋红雨, 李金炎, 云少民. 低分子肝素治疗肾病综合征的疗效分析. 中国医疗前沿, 2012, 7(4):42-43.
17. 许建国. 低分子肝素在肾病综合征中应用观察. 中国现代医药杂志, 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. 刘俊, 栾家杰, 徐文科, 等. 中国汉族人群基于临床特征和基因型华法林个体化给药模型的研究. 中国临床药理学与治疗学, 2014, 19(3):284-289.
20. 汪爱民. 华法林的应用研究进展. 实用心脑肺血管病杂志, 2011, 19(9):1619-1620.
21. 《中国药物经济学评价指南》课题组. 中国药物经济学评价指南(2011版). 中国药物经济学, 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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