Nafamostat mesylate and unfractionated heparin for continuous renal replacement therapy anticoagulation: a cost minimization analysis based on decision tree model_Chinese Journal of Evidence-Based Medicine

Authors：

AN Qi , JING Tianyu , ZHA Jingkai , ZOU Jie ,  XU Wei

International Medical Business School, China Pharmaceutical University, Nanjing 211198, P. R. China;

Corresponding author：

XU Wei, Email: xu2005wei@126.com

Keywords：

CRRT; Nafamostat mesylate; Unfractionated heparin; Decision tree model; Cost minimization analysis

DOI：

10.7507/1672-2531.202208085

Video：

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Objective To evaluate the economics of nafamostat mesylate compared with unfractionated heparin for continuous renal replacement therapy anticoagulation. Methods A decision tree model was constructed to calculate the cost difference between the two anticoagulation methods. Survival analysis data comes from retrospective literature in Asian countries. The cost data comes from procurement data and the prices of medical and health services in some regions. A 72-hour scenario analysis is performed and a sensitivity analysis is performed on key parameters. Results The basic analysis results showed that compared with the unfractionated heparin group, the total cost difference of nafamostat in the 144-hour CRRT treatment was 5 350.34 yuan, and the unfractionated heparin was more economical. In the 72-hour scenario analysis, unfractionated heparin is also more economical. Univariate sensitivity analysis showed that the cost of single-use hemodialysis filters and supporting pipelines and the cost of plasma antithrombin Ⅲ activity (AT-Ⅲ) measurement had a greater impact on the change of the cost difference. The results of probability sensitivity analysis show that the model structure is stable and robust. When the unit price of nafamostat is about 110.82 yuan/piece, the cost of nafamostat and unfractionated heparin in 144-hour CRRT treatment is both 19 185.37 yuan, and the cost difference is 0.Conclusion When the unit price of nafamostat mesylate drops to a sufficiently low level, it could have an advantageous health economy.

Citation： AN Qi, JING Tianyu, ZHA Jingkai, ZOU Jie, XU Wei. Nafamostat mesylate and unfractionated heparin for continuous renal replacement therapy anticoagulation: a cost minimization analysis based on decision tree model. Chinese Journal of Evidence-Based Medicine, 2023, 23(2): 139-146. doi: 10.7507/1672-2531.202208085 Copy

1.	潘晨亮, 赵晶, 张博, 等. 连续肾脏替代治疗在心血管危重症患者中的应用研究进展. 中国心血管病研究, 2022, 20(5): 466-470.
2.	陈惠德. 连续肾脏替代治疗在危重症患者中的应用. 医师进修杂志, 2003, (19): 5-7.
3.	周辉. 探讨SOFA评分与RIFLE分期在连续性肾脏替代治疗时机选择中的价值. 南昌: 南昌大学, 2015.
4.	潘旭东, 赵宏磊, 刘宁宁, 等. 连续性肾脏替代治疗在急性StanfordA型主动脉夹层术后急性肾损伤中的应用. 心肺血管病杂志, 2016, 35(3): 189-192,199.
5.	方志成, 周昌娥, 郑翔, 等. 不同容量连续性肾脏替代治疗严重腹腔感染对比研究. 陕西医学杂志, 2011, 40(3): 302-304.
6.	董书娅, 杨金芳, 佘丽平, 等. 两种抗凝方法在消化道出血患者行连续性肾替代治疗中的应用. 吉林医学, 2015, 36(3): 518-519.
7.	张颖钒. 基于APACHEⅡ联合动态SOFA评分的分级监测在CRRT患者中的应用. 遵义: 遵义医学院, 2016.
8.	李果. 武汉市连续性肾替代治疗应用现况及成本测算研究. 武汉: 武汉大学, 2018.
9.	Hwang SD, Hyun YK, Moon SJ, et al. Nafamostat mesilate for anticoagulation in continuous renal replacement therapy. Int J Artif Organs, 2013, 36(3): 208-216.
10.	李敏侠, 李月红, 蔡广研. 连续性肾脏替代治疗抗凝方式的选择. 临床内科杂志, 2017, 34(4): 227-229.
11.	吴克. 人抗凝血酶Ⅲ的特性与应用. 国外医学. 输血及血液学分册, 1996, (1): 28-31.
12.	何艳. 血栓前体蛋白和抗凝血酶-Ⅲ在糖尿病微血管病变患者中的检测及临床意义. 南充: 川北医学院, 2013.
13.	Etchells E, McLeod RS, Geerts W, et al. Economic analysis of low-dose heparin vs the low-molecular-weight heparin enoxaparin for prevention of venous thromboembolism after colorectal surgery. Arch Intern Med, 1999, 159(11): 1221-1228.
14.	Lopes DG, Tamayo A, Schipp B, et al. Cost-effectiveness of edoxaban vs low-molecular-weight heparin and warfarin for cancer-associated thrombosis in Brazil. Thromb Res, 2020, 196: 4-10.
15.	Lim JY, Kim JB, Choo SJ, et al. Anticoagulation during extracorporeal membrane oxygenation; nafamostat mesilate versus heparin. Ann Thorac Surg, 2016, 102(2): 534-539.
16.	Makino S, Egi M, Kita H, et al. Comparison of nafamostat mesilate and unfractionated heparin as anticoagulants during continuous renal replacement therapy. Int J Artif Organs, 2016, 39(1): 16-21.
17.	Baek NN, Jang HR, Huh W, et al. The role of nafamostat mesylate in continuous renal replacement therapy among patients at high risk of bleeding. Ren Fail, 2012, 34(3): 279-285.
18.	Choi JY, Kang YJ, Jang HM, et al. Nafamostat mesilate as an anticoagulant during continuous renal replacement therapy in patients with high bleeding risk: a randomized clinical trial. Medicine (Baltimore), 2015, 94(52): e2392.
19.	Han W, San Bok J, Cho HJ, et al. Single-center experience of extracorporeal membrane oxygenation mainly anticoagulated with nafamostat mesilate. J Thorac Dis, 2019, 11(7): 2861-2867.
20.	Malhotra AK, Goldberg SR, McLay L, et al. DVT surveillance program in the ICU: analysis of cost-effectiveness. PLoS One, 2014, 9(9): e106793.
21.	Douketis JD, Kearon C, Bates S, et al. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA, 1998, 279(6): 458-462.
22.	Reeves JH, Cumming AR, Gallagher L, et al. A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration. Crit Care Med, 1999, 27(10): 2224-2228.
23.	国家统计局. 全国年度统计公报, 2022-2-28. Available at: http://www.stats.gov.cn/.
24.	药智网. 甲磺酸萘莫司他说明书. Available at: https://www.yaozh.com/.
25.	北村伸哉, 张凌. 甲磺酸萘莫司他在连续性肾脏替代治疗中的抗凝应用. 华西医学, 2018, 33(7): 801-805.
26.	药智网. 萘莫司他价格. Available at: https://www.yaozh.com/.
27.	李元忠, 安丽丽. 连续性肾替代治疗: 如何做到适宜的抗凝治疗. 中华重症医学电子杂志(网络版), 2017, 3(3): 214-219.
28.	上海市卫生健康委员会. 医疗服务项目价格(2017版)公示. Available at: https://wsjkw.sh.gov.cn/wsj/download/jgb_2017.pdf.
29.	珠海市医疗保障局. 关于珠海市部分现行医疗服务价格文件及目录的通告, 2019-04-28. Available at: http://www.zhuhai.gov.cn/ylbzj/gkmlpt/content/1/1885/post_1885673.html#6136.
30.	辽宁省医疗保障局. 关于制定辽宁省公立医疗机构医疗服务项目最高限价及有关问题的通知, 2019-12-30. Available at: http://ybj.ln.gov.cn/zwgk/zcwj/zcwj/202005/t20200512_3851110.html.
31.	江西省医疗保障局. 关于《江西省医疗服务价格项目目录(2021版) (征求意见稿)》的公示, 2021-05-25. Available at: http://ybj.jiangxi.gov.cn/art/2021/5/25/art_28422_3375262.html.
32.	李志方, 黄丽霞, 陈名桂, 等. CRRT静脉壶堵塞时紧急回血通路的搭建及应用. 当代护士(上旬刊), 2021, 28(11): 135-136.
33.	国家卫健委, 国家发改委. 关于调整公民临床用血收费标准的通知. Available at: http://www.gov.cn/gongbao/content/2006/content_253027.htm.
34.	黄雪芳, 孔耀中, 肖观清, 等. 血液净化中心不同透析液供应方式的成本对比. 现代医院, 2017, 17(6): 823-825.
35.	镜湖区经济和信息化局. 镜湖区经信局关于采购疫情防控物资的询价结果公示. Available at: https://www.whjhq.gov.cn/xwdt/gggs/18354380.html, 2022.
36.	中国政府采购网. 医用手套采购(二次)中标公告, 2022-04-25. Available at: https://www.tianyancha.com/bid/bc560e69347f4944badac2d475028a2b.
37.	泰兴市人民医院. 泰兴市人民医院一次性手术衣中标公告, 2022-01-20. Available at: https://www.tianyancha.com/bid/50542b86482b456a9363e7c9dc8dbb15.
38.	蔡荣根, 曹利明, 李理, 等. 时空奇异性和宇宙监督假设. 中国科学: 物理学力学天文学: 2022, 9: 1-52. Available at: http://kns.cnki.net/kcms/detail/11.5848.N.20220927.1358.002.html.
39.	宝鸡市陈仓区地方志编纂委员会. 宝鸡市陈仓区志(1990~2010). 陕西三秦出版社:陕西地方志丛书, 2018: 1170.
40.	樊丰夷, 吴欣, 张春, 等. 国产透析液过滤器与进口透析液过滤器性能对比. 中国血液净化, 2020, 19(8): 559-561.

1. 潘晨亮, 赵晶, 张博, 等. 连续肾脏替代治疗在心血管危重症患者中的应用研究进展. 中国心血管病研究, 2022, 20(5): 466-470.
2. 陈惠德. 连续肾脏替代治疗在危重症患者中的应用. 医师进修杂志, 2003, (19): 5-7.
3. 周辉. 探讨SOFA评分与RIFLE分期在连续性肾脏替代治疗时机选择中的价值. 南昌: 南昌大学, 2015.
4. 潘旭东, 赵宏磊, 刘宁宁, 等. 连续性肾脏替代治疗在急性StanfordA型主动脉夹层术后急性肾损伤中的应用. 心肺血管病杂志, 2016, 35(3): 189-192,199.
5. 方志成, 周昌娥, 郑翔, 等. 不同容量连续性肾脏替代治疗严重腹腔感染对比研究. 陕西医学杂志, 2011, 40(3): 302-304.
6. 董书娅, 杨金芳, 佘丽平, 等. 两种抗凝方法在消化道出血患者行连续性肾替代治疗中的应用. 吉林医学, 2015, 36(3): 518-519.
7. 张颖钒. 基于APACHEⅡ联合动态SOFA评分的分级监测在CRRT患者中的应用. 遵义: 遵义医学院, 2016.
8. 李果. 武汉市连续性肾替代治疗应用现况及成本测算研究. 武汉: 武汉大学, 2018.
9. Hwang SD, Hyun YK, Moon SJ, et al. Nafamostat mesilate for anticoagulation in continuous renal replacement therapy. Int J Artif Organs, 2013, 36(3): 208-216.
10. 李敏侠, 李月红, 蔡广研. 连续性肾脏替代治疗抗凝方式的选择. 临床内科杂志, 2017, 34(4): 227-229.
11. 吴克. 人抗凝血酶Ⅲ的特性与应用. 国外医学. 输血及血液学分册, 1996, (1): 28-31.
12. 何艳. 血栓前体蛋白和抗凝血酶-Ⅲ在糖尿病微血管病变患者中的检测及临床意义. 南充: 川北医学院, 2013.
13. Etchells E, McLeod RS, Geerts W, et al. Economic analysis of low-dose heparin vs the low-molecular-weight heparin enoxaparin for prevention of venous thromboembolism after colorectal surgery. Arch Intern Med, 1999, 159(11): 1221-1228.
14. Lopes DG, Tamayo A, Schipp B, et al. Cost-effectiveness of edoxaban vs low-molecular-weight heparin and warfarin for cancer-associated thrombosis in Brazil. Thromb Res, 2020, 196: 4-10.
15. Lim JY, Kim JB, Choo SJ, et al. Anticoagulation during extracorporeal membrane oxygenation; nafamostat mesilate versus heparin. Ann Thorac Surg, 2016, 102(2): 534-539.
16. Makino S, Egi M, Kita H, et al. Comparison of nafamostat mesilate and unfractionated heparin as anticoagulants during continuous renal replacement therapy. Int J Artif Organs, 2016, 39(1): 16-21.
17. Baek NN, Jang HR, Huh W, et al. The role of nafamostat mesylate in continuous renal replacement therapy among patients at high risk of bleeding. Ren Fail, 2012, 34(3): 279-285.
18. Choi JY, Kang YJ, Jang HM, et al. Nafamostat mesilate as an anticoagulant during continuous renal replacement therapy in patients with high bleeding risk: a randomized clinical trial. Medicine (Baltimore), 2015, 94(52): e2392.
19. Han W, San Bok J, Cho HJ, et al. Single-center experience of extracorporeal membrane oxygenation mainly anticoagulated with nafamostat mesilate. J Thorac Dis, 2019, 11(7): 2861-2867.
20. Malhotra AK, Goldberg SR, McLay L, et al. DVT surveillance program in the ICU: analysis of cost-effectiveness. PLoS One, 2014, 9(9): e106793.
21. Douketis JD, Kearon C, Bates S, et al. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA, 1998, 279(6): 458-462.
22. Reeves JH, Cumming AR, Gallagher L, et al. A controlled trial of low-molecular-weight heparin (dalteparin) versus unfractionated heparin as anticoagulant during continuous venovenous hemodialysis with filtration. Crit Care Med, 1999, 27(10): 2224-2228.
23. 国家统计局. 全国年度统计公报, 2022-2-28. Available at: http://www.stats.gov.cn/.
24. 药智网. 甲磺酸萘莫司他说明书. Available at: https://www.yaozh.com/.
25. 北村伸哉, 张凌. 甲磺酸萘莫司他在连续性肾脏替代治疗中的抗凝应用. 华西医学, 2018, 33(7): 801-805.
26. 药智网. 萘莫司他价格. Available at: https://www.yaozh.com/.
27. 李元忠, 安丽丽. 连续性肾替代治疗: 如何做到适宜的抗凝治疗. 中华重症医学电子杂志(网络版), 2017, 3(3): 214-219.
28. 上海市卫生健康委员会. 医疗服务项目价格(2017版)公示. Available at: https://wsjkw.sh.gov.cn/wsj/download/jgb_2017.pdf.
29. 珠海市医疗保障局. 关于珠海市部分现行医疗服务价格文件及目录的通告, 2019-04-28. Available at: http://www.zhuhai.gov.cn/ylbzj/gkmlpt/content/1/1885/post_1885673.html#6136.
30. 辽宁省医疗保障局. 关于制定辽宁省公立医疗机构医疗服务项目最高限价及有关问题的通知, 2019-12-30. Available at: http://ybj.ln.gov.cn/zwgk/zcwj/zcwj/202005/t20200512_3851110.html.
31. 江西省医疗保障局. 关于《江西省医疗服务价格项目目录(2021版) (征求意见稿)》的公示, 2021-05-25. Available at: http://ybj.jiangxi.gov.cn/art/2021/5/25/art_28422_3375262.html.
32. 李志方, 黄丽霞, 陈名桂, 等. CRRT静脉壶堵塞时紧急回血通路的搭建及应用. 当代护士(上旬刊), 2021, 28(11): 135-136.
33. 国家卫健委, 国家发改委. 关于调整公民临床用血收费标准的通知. Available at: http://www.gov.cn/gongbao/content/2006/content_253027.htm.
34. 黄雪芳, 孔耀中, 肖观清, 等. 血液净化中心不同透析液供应方式的成本对比. 现代医院, 2017, 17(6): 823-825.
35. 镜湖区经济和信息化局. 镜湖区经信局关于采购疫情防控物资的询价结果公示. Available at: https://www.whjhq.gov.cn/xwdt/gggs/18354380.html, 2022.
36. 中国政府采购网. 医用手套采购(二次)中标公告, 2022-04-25. Available at: https://www.tianyancha.com/bid/bc560e69347f4944badac2d475028a2b.
37. 泰兴市人民医院. 泰兴市人民医院一次性手术衣中标公告, 2022-01-20. Available at: https://www.tianyancha.com/bid/50542b86482b456a9363e7c9dc8dbb15.
38. 蔡荣根, 曹利明, 李理, 等. 时空奇异性和宇宙监督假设. 中国科学: 物理学力学天文学: 2022, 9: 1-52. Available at: http://kns.cnki.net/kcms/detail/11.5848.N.20220927.1358.002.html.
39. 宝鸡市陈仓区地方志编纂委员会. 宝鸡市陈仓区志(1990~2010). 陕西三秦出版社:陕西地方志丛书, 2018: 1170.
40. 樊丰夷, 吴欣, 张春, 等. 国产透析液过滤器与进口透析液过滤器性能对比. 中国血液净化, 2020, 19(8): 559-561.

Chinese Journal of Evidence-Based Medicine

Nafamostat mesylate and unfractionated heparin for continuous renal replacement therapy anticoagulation: a cost minimization analysis based on decision tree model

Abstract Full text Figures/Tables Video References Cited by

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