PDF(Pubmed)
Abstract：
UNASSIGNED: Direct oral anticoagulants (DOACs) have demonstrated clinical benefits and better patient adherence over low-molecular-weight heparin (LMWH) in treating patients with cancer-associated venous thrombosis (CAT). We aimed to compare the cost-effectiveness of DOACs against LMWH in patients with CAT from the perspective of the Hong Kong healthcare system.
UNASSIGNED: A Markov state-transition model was performed to estimate the incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALYs) for DOACs and LMWH in a hypothetical cohort of 10,000 patients with CAT over a 5-year lifetime horizon. The model was primarily based on the health states of no event, recurrent venous thromboembolism, bleeding, and death. Transition probabilities, relative risks, and utilities were derived from the literature. Resource cost data were obtained from the Hong Kong Hospital Authority. Deterministic and probabilistic sensitivity analyses tested the robustness of the results.
UNASSIGNED: Relative to LMWH, DOACs were associated with increased QALYs (1.52 versus 1.50) at a lower medical cost of USD 2,232 versus 8,224 in five years. The cost of LMWH was the main contributor to the outcome. Out of 10,000 simulated cases, DOACs were dominant in 15.8% and cost-effective in 42.1%, at the willingness-to-pay threshold of USD 148,392 per additional QALY.
UNASSIGNED: DOACs were associated with greater QALY improvements and lower overall costs compared to LMWH. Accounting for uncertainty, DOACs were between cost-effective and dominant in 57.9% of cases. DOACs are a cost-effective alternative to LMWH in the management of CAT in Hong Kong.
UNASSIGNED: A Markov state-transition model was performed to estimate the incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALYs) for DOACs and LMWH in a hypothetical cohort of 10,000 patients with CAT over a 5-year lifetime horizon. The model was primarily based on the health states of no event, recurrent venous thromboembolism, bleeding, and death. Transition probabilities, relative risks, and utilities were derived from the literature. Resource cost data were obtained from the Hong Kong Hospital Authority. Deterministic and probabilistic sensitivity analyses tested the robustness of the results.
UNASSIGNED: Relative to LMWH, DOACs were associated with increased QALYs (1.52 versus 1.50) at a lower medical cost of USD 2,232 versus 8,224 in five years. The cost of LMWH was the main contributor to the outcome. Out of 10,000 simulated cases, DOACs were dominant in 15.8% and cost-effective in 42.1%, at the willingness-to-pay threshold of USD 148,392 per additional QALY.
UNASSIGNED: DOACs were associated with greater QALY improvements and lower overall costs compared to LMWH. Accounting for uncertainty, DOACs were between cost-effective and dominant in 57.9% of cases. DOACs are a cost-effective alternative to LMWH in the management of CAT in Hong Kong.
摘要：
与低分子量肝素(LMWH)相比，直接口服抗凝剂(DOAC)在治疗癌症相关静脉血栓形成(CAT)患者方面已显示出临床益处和更好的患者依从性。我们旨在从香港医疗保健系统的角度比较DOAC与LMWH在CAT患者中的成本效益。
■采用马尔可夫状态转换模型来估算在5年寿命期内10,000名CAT患者的假设队列中DOAC和LMWH每质量调整生命年(QALY)的增量成本效益比(ICER)。该模型主要基于无事件的健康状态，复发性静脉血栓栓塞,出血,和死亡。转移概率,相对风险，和公用事业是从文献中得出的。资源成本数据来自香港医院管理局。确定性和概率敏感性分析测试了结果的稳健性。
■相对于LMWH，DOAC与增加的QALYs（1.52对1.50）相关，五年内医疗费用较低，为2,232美元对8,224美元。LMWH的成本是结果的主要贡献者。在10,000个模拟案例中，DOAC占15.8%，成本效益占42.1%，在每额外QALY148,392美元的支付意愿门槛下。
■与LMWH相比，DOAC与更大的QALY改进和更低的总成本相关。考虑不确定性，在57.9%的病例中，DOAC介于成本效益和优势之间。在香港的CAT管理中，DOAC是LMWH的具有成本效益的替代方案。
■采用马尔可夫状态转换模型来估算在5年寿命期内10,000名CAT患者的假设队列中DOAC和LMWH每质量调整生命年(QALY)的增量成本效益比(ICER)。该模型主要基于无事件的健康状态，复发性静脉血栓栓塞,出血,和死亡。转移概率,相对风险，和公用事业是从文献中得出的。资源成本数据来自香港医院管理局。确定性和概率敏感性分析测试了结果的稳健性。
■相对于LMWH，DOAC与增加的QALYs（1.52对1.50）相关，五年内医疗费用较低，为2,232美元对8,224美元。LMWH的成本是结果的主要贡献者。在10,000个模拟案例中，DOAC占15.8%，成本效益占42.1%，在每额外QALY148,392美元的支付意愿门槛下。
■与LMWH相比，DOAC与更大的QALY改进和更低的总成本相关。考虑不确定性，在57.9%的病例中，DOAC介于成本效益和优势之间。在香港的CAT管理中，DOAC是LMWH的具有成本效益的替代方案。
