抗凝药物治疗肝硬化门静脉血栓的成本-效果分析  

Cost-effectiveness Analysis of Anticoagulants in the Treatment of Portal Vein Thrombosis in Liver Cirrhosis

作　　者：王晓剑[1] 张志琪 徐菀佚 徐烨 刘冉佳 崔向丽 WANG Xiaojian;ZHANG Zhiqi;XU Wanyi;XU Ye;LIU Ranjia;CUI Xiangli(Department of Pharmacy,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院药学部,北京100050

出　　处：《医药导报》2023年第7期1080-1085,共6页Herald of Medicine

基　　金：北京友谊医院科研启动基金资助项目(yygdktgl2021-3);北京市医院管理中心2020年培育项目(PG2020002);北京市通州区科技计划项目(KJ2022CX039)。

摘　　要：目的对不同抗凝药物治疗肝硬化门静脉血栓(PVT)进行成本-效果分析,为临床选择具有经济性的肝硬化PVT抗凝药物治疗方案提供参考。方法从医疗机构角度构建决策树模型,比较不同抗凝药物治疗方案治疗肝硬化PVT的经济性。以治疗成功率作为健康产出,成本数据来源于首都医科大学附属北京友谊医院真实医疗环境的价格。对各抗凝方案进行成本-效果分析,并对结果稳健性进行敏感性分析。结果与非抗凝组相比,华法林方案的增量成本-效果比(ICER)为1204.70元,直接口服抗凝药(DOACs)方案的ICER为2600.73元,低分子肝素(LMWH)方案的ICER为17689.32元。在意愿支付阈值(WTP)为14590.90元的情况下,DOACs治疗方案最具有经济性。单因素敏感性分析结果表明,DOACs抗凝药物每日成本对结果的影响最大。当DOACs日成本高于21.03元时,华法林比DOACs更有经济性。成本-效果可接受曲线显示,WTP为14590.90元时,DOACs具有经济性的概率为53.7%。结论DOACs治疗肝硬化PVT的方案较华法林和LMWH方案更有经济性,该结论还需多中心临床研究验证。Objective To compare the cost-effectiveness of different anticoagulants for the treatment of portal vein thrombosis(PVT)in cirrhosis,and to provide a reference for clinical selection of economic anticoagulants for these patients.Methods A decision tree model was constructed to compare the economics of different anticoagulants for the treatment of PVT in cirrhosis from the healthcare provider's perspective.The treatment success rate was used as the health outcome,and cost data were obtained from prices in a real medical setting of our hospital.A cost-effectiveness analysis was performed for each anticoagulation regimen,and sensitivity analysis was performed on the results to verify the robustness of the results.Results Compared to the non-anticoagulation group,the incremental cost-effectiveness ratio(ICER)of the warfarin regimen was 1204.70 yuan,the ICER of the direct oral anticoagulants(DOACs)regimen was 2600.73 yuan,and the ICER of the low molecular weight heparin(LMWH)regimen was 17689.32 yuan.DOACs regimen was most cost-effective at a willingness-to-pay(WTP)threshold of 14590.90 yuan.The results of the univariate sensitivity analysis showed that the daily cost of DOACs had the greatest impact on the outcome.Warfarin was more cost-effective than DOACs when the daily cost of DOACs was higher than 21.03 yuan.The cost-effectiveness acceptability curve indicated that WTP was 14590.90 yuan,the probability of being cost-effective of DOACs was 53.7%.Conclusion DOACs regimen for PVT in cirrhosis is cost-effective compared to warfarin and LMWH regimens,which needs to be confirmed by more clinical studies.

关 键 词：抗凝药物 门静脉血栓 肝硬化 成本-效果分析 

分 类 号：R979.1[医药卫生—药品] R969[医药卫生—药学]