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;
CHENWen, Email: wenchen@fudan.edu.cn; MENGXu, Email: mengxu100@126.com
Anticoagulation management; Economic evaluation; Cost effectiveness analysis
10.7507/1007-4848.20160206
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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