阿哌沙班、利伐沙班、达比加群酯、依诺肝素预防髋膝关节置换术后静脉血栓形成的成本-效果分析

目的：评价阿哌沙班、利伐沙班、达比加群酯、依诺肝素预防髋膝关节置换术后静脉血栓栓塞症的成本-效果比，为临床药物选择提供经济学参考。方法：建立髋膝关节置换术后预防静脉血栓栓塞症的决策树模型，参考Meta分析研究结果确定模型中各节点概率，运行数据模型TreeAge Pro 2011得出成本-效果比。结果：全髋关节置换术中阿哌沙班预防用药成本-效果比3 950.43；利伐沙班预防用药成本-效果比2 900.08；达比加群酯成本-效果比3 149.79；依诺肝素成本-效果比3 763.86，全膝关节置换术中阿哌沙班预防用药成本-效果比1 594.70；利伐沙班预防用药成本-效果比1 169.91；达比加群酯成本-效果比1 266.61；依诺肝素成本-效果比1 524.10。结论：利伐沙班预防髋膝关节置换术术后静脉血栓形成相比阿哌沙班、达比加群酯、依诺肝素更具有经济优势。在预防全膝关节置换术中，依诺肝素相比阿哌沙班、利伐沙班、达比加群酯预防用药增加的成本可被接受。

Cost-effectiveness evaluation of apixaban rivaroxaban dabigartan enoxaparin in the prevention of venous thromboembolism after total hip and knee arthroplasty

OBJECTIVE To evaluate the cost-effectiveness ratio of apixaban, rivaroxaban, dabigatran etexilate, and enoxaparin in preventing venous thromboembolism after hip and knee arthroplasty, and to provide economic reference for clinical drug selection. METHODS A decision-analytic model for the prevention of venous thromboembolism after hip and knee arthroplasty was established. The probability of each node in the model was determined by referring to the results of the meta-analysis study. The cost-effectiveness ratio was obtained by running the data model TreeAge Pro 2011. RESULTS The cost-effectiveness ratio of apixaban prophylaxis in total hip arthroplasty was 3 950.43; Rivaroxaban prophylaxis was 2 900.08; Dabigatran etexilate was 3 149.79; Enoxaparin was 3 763.86; Apixaban prophylaxis in total knee arthroplasty was 1 594.70; Rivaroxaban prophylaxis was 1 169.91; Dabigatran etexilate was 1 266.61; Enoxaparin was 1 524.10. CONCLUSION Rivaroxaban has an economic advantage over apixaban, dabigatran etexilate, and enoxaparin in preventing venous thrombosis after hip and knee arthroplasty. The incremental cost of enoxaparin compared with apixaban, rivaroxaban, and dabigatran etexilate for prophylaxis in total knee arthroplasty is acceptable.