抗凝药物防治癌症患者静脉血栓栓塞症的药物经济学系统评价
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篇名: 抗凝药物防治癌症患者静脉血栓栓塞症的药物经济学系统评价
TITLE: Pharmacoeconomic Systematic Review of Anticoagulants for the Prevention and Therapy of Venous Thrombo- embolism in Cancer Patients
摘要: 目的:系统评价抗凝药物预防或治疗癌症患者静脉血栓栓塞症(VTE)的药物经济性。方法:计算机检索PubMed、Embase、Cochrane图书馆、中国知网、万方数据、维普网、中国生物医学文献服务系统以及TheNHSEconomicEvaluationDatabase、TheHealthyTechnologyAssessmentDatabase、EconLit等数据库,并辅以手工检索,收集不同抗凝药预防或治疗癌症患者VTE的经济学评价研究,检索时限为建库至2020年11月12日。经筛选、提取后,采用卫生经济评估报告标准清单评价纳入文献的质量。采用描述性的方法总结纳入文献的基本特征,并根据用药目的和不同干预分组归纳其经济学结果。结果:共纳入15篇文献,3篇质量优秀,10篇质量良好,其余2篇质量适中。研究分布于中国(1项)、美国(7项)、加拿大(3项)、法国(2项)、荷兰(1项)、巴西(1项)、奥地利(1项)等不同收入水平的国家。对于预防癌症患者VTE,华法林和低分子肝素(LMWH)的经济学评价有待更新;在VTE中高风险的癌症患者中,新型口服抗凝药(NOACs)在中国的经济优势不如美国,但是其在VTE高风险人群中的经济优势却在增加;阿司匹林对比依诺肝素预防骨髓瘤患者VTE具有绝对经济优势。对于治疗癌症患者VTE,LMWH对比华法林在美国不具有成本-效用优势,但是在加拿大和北欧等国家具有明显的经济优势;NOACs对比LMWH能节省总成本,但是美国和巴西的增量效果正负相反。敏感性分析显示,经济学结果对药物价格、血栓发生风险基线率以及不同干预下的不良事件(血栓复发、大出血、死亡)发生风险敏感,其中药物价格和血栓发生基线率能够逆转结论。结论:对于预防癌症患者VTE,与无干预或安慰剂相比,NOACs在不同国家、不同血栓风险人群中的经济性不同;华法林、LMWH的经济性尚未明确;阿司匹林对比依诺肝素的经济优势明显。对于治疗癌症患者VTE,LMWH对比华法林在不同国家的经济优势不同;NOACs对比LMWH能节省成本。经济策略受不同国家的疾病发生风险、医疗体系、药物价格、患者偏好和价值观以及经济水平、成本-效用阈值标准等影响较大,最终的经济决策需要依据不同国家背景而定。
ABSTRACT: OBJECTIVE:To systematicall y review the pharmacoeconomics of anticoagulants for the prevention and therapy of venous thromboembolism (VTE)in cancer patients. METHODS :Retrieved from PubMed ,Embase,Cochrane library ,CNKI, Wanfang database ,VIP,SinoMed,The NHS Economic Evaluation Database ,The Healthy Technology Assessment Database and EconLit,supplemented by manual retrieval ,the economic evaluation studies on the prevention and therapy of VTE in cancer patients with different anticoagulants were collected. The retrieval time was from the inception to Nov. 12th,2020. After screening and extracting ,the Consolidated Health Economic Evaluation Reporting Standards (CHEERS)was used to evaluate the quality of the included literatures. The basic characteristics of the included literatures were summarized by descriptive methods ,and the economic results were summarized according to medication purpose and different intervention grouping. RESULTS :A total of 15 literatures were included. Three literatures were of excellent quality ;ten were of good quality ;and the other two were of moderate quality. Included studies were widely conducted in countries of different economic levels ,including China (1 piece),the United States(7 pieces),Canada(3 pieces),France(2 pieces),the Netherlands (1 piece),Brazil(1 piece)and Austria (1 piece). For preventing VTE in cancer patients ,the economic evaluation results of warfarin and low-molecular-weight heparin (LMWH)needed to be updated. Novel oral anticoagulants (NOACs)for the prevention of VTE were less cost-effective among cancer patients with medium- and high-risk venous thrombosis in China than in the United States ,but the economic advantage increased among the high-risk patients. Compared to enoxaparin ,aspirin was absolutely dominant to preventing VTE in patients with myeloma. For the treatment of VTE in cancer patients ,LMWH was not cost-effective ,compared to warfarin in the United States ;but it was cost-effective in Canada and some countries of Northern Europe. Compared with LMWH ,NOACs could save total cost ,but the incremental utility in the United States and Brazil were opposite. Sensitivity analysis showed that economic results were sensitive to drug prices ,the baseline rate of thrombosis risk ,and the risk of adverse events (thrombosis recurrence ,major bleeding and death ) of different interventions ,the first two of which could reverse the conclusions. CONCLUSIONS :For the prevention of VTE in cancer patients ,compared with no intervention or placebo ,the economic advantages of NOACs were different in different countries or for patients with different thrombosis risk ;the economics of warfarin and LMWH were not yet clear. Aspirin had obvious economic advantages compared with enoxaparin. For the treatment of VTE in cancer patients ,LMWH had different economic advantages compared with warfarin in different countries ;NOACs could save costs compared with LMWH. Economic strategies are greatly affected by the risk of diseases ,medical systems ,drug price ,patient preferences and values ,economic levels ,cost-utility threshold standards in different countries. Therefore ,the final economic strategies need to be based on the contexts of different countries.
期刊: 2021年第32卷第07期
作者: 周谦,高笑男,高敬林,冯章英,王明霞
AUTHORS: ZHOU Qian,GAO Xiaonan,GAO Jinglin,FENG Zhangying,WANG Mingxia
关键字: 抗凝药物;癌症;静脉血栓栓塞症;药物经济学;系统评价
KEYWORDS: Anticoagulants;Cancer;Venous thromboembolism ;Pharmocoeconomics;Systematic review
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