Pharmacoeconomic Systematic Review of Anticoagulants for the Prevention and Therapy of Venous Thrombo- embolism in Cancer Patients / 中国药房

ABSTRACT

OBJECTIVE：To systematicall y 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.