A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism

ALDAĞ, Yağmur; EKİM, Numan; OĞUZÜLGEN, İPEK KIVILCIM; Türk, Murat

A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism

Murat TÜRK, (Yerköy Devlet Hastanesi, Göğüs Hastalıkları Kliniği, Yozgat, Türkiye)

Yağmur ALDAĞ, (Gazi Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Ankara, Türkiye)

İpek KIVILCIM OĞUZÜLGEN, (Gazi Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Ankara, Türkiye)

Numan EKİM (Gazi Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, Ankara, Türkiye)

Tüberküloz ve Toraks

3 0

Yıl: 2016 Cilt: 64 Sayı: 3 Sayfa Aralığı: 198 - 205 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism

Öz:

Giriş: Yeni nesil oral antikoagülanlar (rivaroksaban, dabigatran, apiksaban) yakın zamanda pulmoner emboli (PE) tedavisi için onay almış ilaçlardır. Başlangıç ve idame tedavisinde kullanılan ilaçların doğrudan ve dolaylı maliyetleri bulunmaktadır. Spesifik bir hasta grubunda ortaya çıkan bu maliyetlerin gösterilmesi, klinisyenlere tedavi seçimlerinde yardımcı olabilecektir. Bu çalışmada PE tedavisinde kullanılabilecek farklı antikoagülanlarla ortaya çıkan maliyetlerin karşılaştırılması amaçlanmıştır. Ayrıca düşük komplikasyon riski bulunan hasta grubu belirlenerek bu grupta başlangıç (ilk 5-10 gün) ve idame (başlangıç tedavisinin bitiminden itibaren) tedavi maliyetleri analiz edilmiştir. Materyal ve Metod: PE tanısı ile hastane yatışı yapılan ve en az 3 ay varfarin tedavisi alan 118 hastanın verileri retrospektif olarak değerlendirildi. Doğrudan medikal ve nonmedikal maliyetler belirlendi. İdame tedavide varfarin kullanımına bağlı gerçek maliyetler ve rivaroksaban, dabigatran, apiksaban ve enoksaparin kullanımına bağlı tahmini maliyetler belirlendi ve karşılaştırıldı. Düşük komplikasyon riski bulunan 49 hastada ortaya çıkabilecek tahmini başlangıç ve idame tedavi maliyetleri belirlenerek karşılaştırıldı. Bulgular: Varfarin ile idame tedavisine devam eden hastalarda ortaya çıkan ortalama toplam maliyet, yeni nesil oral antikoagülanlara göre yüksek bulundu (varfarin için 286.5 EUR, rivaroksaban için 233.3 EUR, dabigatran için 231.7 EUR ve apiksaban için 229 EUR). Hastane yatışı olmadan tedavi edilebilecek olan düşük komplikasyon riskine sahip hastalarda kullanılabilecek alternatif tedavi seçenekleri ile ortaya çıkan maliyetler, varfarin tedavisine göre daha düşük bulundu (varfarin için 883.1 EUR, rivaroksaban için 254.3 EUR, apiksaban için 238 EUR ve enoksaparin için 810.6 EUR). Sonuç: İdame tedavide yeni nesil oral antikoagülanlarla ortaya çıkabilecek maliyetler daha düşük bulunmuştur. Hastane yatışı yapılmayabilecek düşük komplikasyon riskine sahip hastalarda tercih edilecek alternatif tedavi seçenekleri daha düşük maliyetler ortaya çıkacaktır.

Anahtar Kelime:

Konular: Solunum Sistemi Kulak, Burun, Boğaz

Akut pulmoner embolide varfarin ile enoksaparin veya yeni oralantikoagülanların kullanımının maliyetlerinin karşılaştırılması

Öz:

Introduction: Recently, novel oral anticoagulants (rivaroxaban, dabigatran, apixaban) have been approved for pulmonary embolism (PE) treatment. Each anticoagulant used during initial and maintenance therapy has direct and indirect costs for healthcare systems. Demonstrating the costs of treatment with different anticoagulants in a specific patient group will be helpful for clinicians determining treatment strategies. Materials and Methods: Retrospective data of 118 patients with PE who were hospitalized and treated with warfarin for at least 3 months were evaluated. Direct medical and nonmedical costs were calculated. True costs with warfarin and modeled costs with rivaroxaban, dabigatran, apixaban and enoxaparine were calculated and compared for maintenance therapy. Estimated costs of initial and maintenance treatment with different anticoagulants were compared for the 49 patients with low complication risk. Results: The average total cost of maintenance treatment with warfarin was found to be higher than the novel oral anticoagulants (EUR286.5 for warfarin, EUR233.3 for rivaroxaban, EUR231.7 for dabigatran, and EUR229.6 for apixaban). In patients with low complication risk, who could be treated without hospitalization, alternative treatment regiments were found to cost less than warfarin treatment (EUR883.1 for warfarin, EUR254.3 for rivaroxaban, EUR238 for apixaban, and EUR810.6 for enoxaparine). Conclusion: Maintenance therapy with novel oral anticoagulant costs less than warfarin treatment. In patients with lower complication risks, alternative regimens that do not require hospitalization could cost less.

Anahtar Kelime:

Konular: Solunum Sistemi Kulak, Burun, Boğaz

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

The Columbus Investigators. Low-Molecular-Weight hepa- rin in the treatment of patients with venous thromboembo- lism. N Eng J Med 1997;337:657-62.
EINSTEIN Investigators, Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS. Oral rivar- oxaban for symptomatic venous thromboembolism. N Eng J Med 2010;363:2499-510.
Rudd KM, Phillips EL. New oral anticoagulants in the treat- ment of pulmonary embolism: efficacy, bleeding risk, and monitoring. Thrombosis 2013;2013;973710.
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. American College of Chest Physicians. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(Suppl 2): e419S-94S.
Arseven O, Sevinç C, Alataş F, Ekim N, Erkan L, Fındık S, et al. Türk Toraks Derneği Pulmoner Tromboembolizm Tanı ve Tedavi Uzlaşı Raporu. Turkish Thoracic Journal 2009;10 (Suppl 11):S1-S49.
Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al; The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: Eur Heart J Epub 2014 Aug 29.
Spyropoulos AC, Lin J. Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations. J Manag Care Pharm 2007;13:475-86.
Weitz JI, Gross PL. New oral anticoagulants: which one should my patient use? Hematology Am Soc Hematol Educ Program 2012;2012:536-40.
EINSTEIN-PE Investigators. Oral rivaroxaban for the treat- ment of symptomatic pulmonary embolism. N Eng J Med 2012; 366:1287-97.
Beckman JA, Dunn K, Sasahara AA, Goldhaber SZ. Enoxaparin monotherapy without oral anticoagulation to treat acute symptomatic pulmonary embolism. Thromb Haemost 2003;89:953-8.
Lefebvre P, Coleman CI, Bookhart BK, Wang ST, Mody SH, Tran KN, et al. Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism. J Med Econ 2014;17:52-64.
Mody SH, Huynh L, Zhuo DY, Tran KN, Lefebvre P, Bookhart B. A cost-analysis model for anticoagulant treatment in the hospital setting. J Med Econ 2014;17:492-98.
Lee S, Anglade MW, Pham D, Pisacane R, Kluger J, Coleman CI. Cost-effectiveness of rivaroxaban compared to warfarin for stroke prevention in atrial fibrillation. Am J Cardiol 2012;110:845-51.
Seaman CD, Smith KJ, Ragni MV. Cost-effectiveness of rivar- oxaban versus warfarin anticoagulation for the prevention of recurrent venous thromboembolism: a U.S. perspective. Thromb Res 2013;132:647-51.
Kleintjens J, Li X, Simoens S, Thijs V, Goethals M, Rietzschel ER, et al. Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting. Pharmacoeconomics 2013;31:909-18.
Gómez-Outes A, Avendaño-Solá C, Terleira-Fernández AI, Vargas-Castrillón E. Pharmacoeconomic evaluation of dabigatran, rivaroxaban and apixaban versus enoxaparin for the prevention of venous thromboembolism after total hip or knee replacement in Spain. Pharmacoeconomics 2014;32:919-36.
Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010;170:1383-9.
Chan CM, Woods C, Shorr AF. The validation and reproducibility of the pulmonary embolism severity index. J Thromb Haemost 2010;8:1509-14.
Aujesky D, Roy PM, Verschuren F, Righini M, Osterwalder J, Egloff M. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet 2011;378:41-8.
Ozsu S, Ozlu T, Sentürk A, Uçar EY, Kırkıl G, Kadıoğlu EE; TUPEG Study Investigators. Combination and comparison of two models in prognosis of pulmonary embolism: results from Turkey Pulmonary Embolism Group (TUPEG) study. Thromb Res 2014;133:1006-10.
Page RL, Ghushchyan V, Gifford B, Read RA, Raut M, Bookhart BK, et al. Hidden costs associated with venous thromboembolism. J Occup Environ Med 2014;56:979-85.

APA	Türk M, ALDAĞ Y, OĞUZÜLGEN İ, EKİM N (2016). A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism. , 198 - 205.
Chicago	Türk Murat,ALDAĞ Yağmur,OĞUZÜLGEN İPEK KIVILCIM,EKİM Numan A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism. (2016): 198 - 205.
MLA	Türk Murat,ALDAĞ Yağmur,OĞUZÜLGEN İPEK KIVILCIM,EKİM Numan A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism. , 2016, ss.198 - 205.
AMA	Türk M,ALDAĞ Y,OĞUZÜLGEN İ,EKİM N A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism. . 2016; 198 - 205.
Vancouver	Türk M,ALDAĞ Y,OĞUZÜLGEN İ,EKİM N A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism. . 2016; 198 - 205.
IEEE	Türk M,ALDAĞ Y,OĞUZÜLGEN İ,EKİM N "A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism." , ss.198 - 205, 2016.
ISNAD	Türk, Murat vd. "A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism". (2016), 198-205.

APA	Türk M, ALDAĞ Y, OĞUZÜLGEN İ, EKİM N (2016). A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism. Tüberküloz ve Toraks, 64(3), 198 - 205.
Chicago	Türk Murat,ALDAĞ Yağmur,OĞUZÜLGEN İPEK KIVILCIM,EKİM Numan A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism. Tüberküloz ve Toraks 64, no.3 (2016): 198 - 205.
MLA	Türk Murat,ALDAĞ Yağmur,OĞUZÜLGEN İPEK KIVILCIM,EKİM Numan A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism. Tüberküloz ve Toraks, vol.64, no.3, 2016, ss.198 - 205.
AMA	Türk M,ALDAĞ Y,OĞUZÜLGEN İ,EKİM N A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism. Tüberküloz ve Toraks. 2016; 64(3): 198 - 205.
Vancouver	Türk M,ALDAĞ Y,OĞUZÜLGEN İ,EKİM N A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism. Tüberküloz ve Toraks. 2016; 64(3): 198 - 205.
IEEE	Türk M,ALDAĞ Y,OĞUZÜLGEN İ,EKİM N "A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism." Tüberküloz ve Toraks, 64, ss.198 - 205, 2016.
ISNAD	Türk, Murat vd. "A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism". Tüberküloz ve Toraks 64/3 (2016), 198-205.