Page 93 - 《中国药房》2021年07期

Pharmacoeconomic Systematic Review of Anticoagulants for the Prevention and Therapy of Venous
Thromboembolism in Cancer Patients
ZHOU Qian，GAO Xiaonan，GAO Jinglin，FENG Zhangying，WANG Mingxia（Dept. of Clinical Pharmacology，
the Fourth Hospital of Hebei Medical University，Shijiazhuang 050011，China）

ABSTRACT OBJECTIVE：To systematically 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.
KEYWORDS Anticoagulants；Cancer；Venous thromboembolism；Pharmocoeconomics；Systematic review

静脉血栓栓塞症（VTE）是造成癌症患者死亡的重 （Khorana 评分≥3）的门诊化疗癌症患者以及多发性骨
要原因之一，主要包括深静脉血栓（DVT）和肺栓塞 髓瘤患者中进行 VTE 预防 [2，4] 。美国临床肿瘤协会
[1]
（PE） 。在癌症患者中，VTE 的累计发生率约为 1％～ （ASCO）和国际血栓与止血学会（ISTH）相关指南建议
8％ ，是普通患者血栓风险的 4.1 倍 。同时，癌症相关 采用利伐沙班（Rivaroxaban）作为癌症患者 VTE 的一
[2]
血栓（CAT）患者在抗凝治疗期间还面临复发和出血的 级预防用药，该药适用的癌症患者范围更广泛，包括起
[1]
风险 。最近一项研究发现，伴有 VTE 的癌症患者住院 始化疗、血栓中高风险（Khorana 评分≥2）、无药物相互
率是不伴有VTE的癌症患者的3倍，且医疗费用增加了 作用且无出血高风险（如胃肠道癌症）的门诊癌症患
[3]
30 538 美元 。因此，预防或治疗癌症患者 VTE 不仅需 者 [1，5] 。依据血栓发生部位和复发风险，指南建议伴有
要考虑抗凝药物的安全性和有效性，而且还需要关注其 VTE的癌症患者的抗凝时间至少持续3～12个月，甚至
经济性。 无限期抗凝 [2，4] 。目前，针对癌症患者防治VTE的抗凝药
目前，用于防治 VTE 的抗凝药物包括普通肝素 物的有效性和安全性研究较多，但缺乏此类药物经济性
（UFH）、低 分 子 肝 素（LMWH）、磺 达 肝 癸 钠 的相关研究 [5－6] 。因此，本文通过系统检索、总结归纳防
（Fondaparinux）、华法林（Warfarin）、新型口服抗凝剂 治癌症患者VTE的抗凝药物的经济学研究，为临床合理
（NOACs）等。最新国内外指南均建议在血栓高风险 用药和医药卫生决策提供经济学依据。

中国药房 2021年第32卷第7期 China Pharmacy 2021 Vol. 32 No. 7 ·851 ·