Pharmacoeconomical analysis of use of the low-molecular weight heparins for prevention of the venous tromboembolism in the conditions of multidisciplinary hospital
Abstract
for the first time in the Russian conditions the pharmacoeconomic analysis examined the application dalteparin in comparison with other low-molecular-weight heparins in patients with high risk of venous tromboembolism at the multifield hospital. On the basis of the systematic analysis of literature, two pharmacoeconomic models were constructed. The main model evaluated efficacy of thromboprophylactic strategy in surgical and therapeutic patients. The additional model included the patient with signigicant renal insufficiency with high risk of development of venous tromboembolism at hospitalization. This study estimated the cost of illness, probability of development different events in varied strategy of prevention, including side effects. In addition the sensitivity analysis was carried out. As a result, this study shown that the use of dalteparin in comparison with other low-molecularweight heparins in patients with high risk of venous tromboembolism in the conditions of the multifield hospital is economically rational medical technology.
About the Authors
A. S. Kolbin
Saint Petersburg State University
Russian Federation
Russian Federation
I. A. Vilyum
Saint Petersburg State University
Russian Federation
Russian Federation
M. A. Proskurin
Saint Petersburg State University
Russian Federation
Russian Federation
Yu. E. Balykina
Saint Petersburg State University
Russian Federation
Russian Federation
References
1. Авксентьева М.А., Герасимов Б.В., Сура М.В. Клиникоэкономический анализ (оценка, выбор медицинских технологий и управления качеством медицинской помощи) / под ред. П.А. Воробьева. М. 2004; 404 с.
2. Белоусов Ю.Б. Планирование и проведение клинических исследований лекарственных средств. М. 2000; 579 с.
3. Генеральное тарифное соглашение на 2012 год (ОМС). http://www.spboms.ru/kiop/main?page_id=338.
4. Информационный портал ОМС Санкт-Петербурга
5. Колосовская Е.Н., Техова И.Г., Калинина З.П., Герман А.М., Ворошилова О.И., Солдатенкова Ж.М. Вопросы организации эпидемиологического наблюдения в условиях отделения реанимации и интенсивной терапии (ОРИТ). СПб, 2005. 12 с.
6. Об утверждении отраслевого стандарта «Клиникоэкономические исследования. Общие положения»: Приказ №163 Министерства здравоохранения Российской Федерации от 27.05.2011.
7. Постановление Правительства РФ от 25 июля 2012 г. «О программе государственных гарантий бесплатного оказания гражданам медицинской помощи на 2013 год и на плановый период 2014 и 2015 годов», http://www.rosminzdrav.ru/docs/doc_projects/858.
8. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология. 2010; 1: 2-37.
9. Сайт Государственного реестра лекарственных средств. http://grls.rosminzdrav.ru/.
10. Справочная система о наличии лекарств в аптеках г. Москвы – Медлюкс. [Электронный ресурс]. URL: www.medlux.ru.
11. Стандарт специализированной медицинской помощи при тромбоэмболии легочных артерий от 9.11.2012 г., № 873н. http:// minjust.consultant.ru/
12. Стандарт специализированной медицинской помощи при остром тромбозе в системе верхней и нижней полых вен от 9.11.2012 г., № 835н. http://minjust.consultant.ru/
13. Хорошилов С.Е. Предупреждение и лечение острой почечной недостаточности при критических состояниях: автореф. дисс. … докт. мед. наук. М. 2007; 46 с.
14. Цены на медицинские услуги СПБ ГУЗ «Городская покровская больница». 2012 г. (http://www.pokrov.spb.ru/assortiment/medic/laboratory/list_1.html)
15. Явелов И.С. Венозный тромбоз и тромбоэмболия легочной артерии: профилактика, диагностика и лечение (часть 1). Атеротромбоз. 2009; 2 (3): 30-47.
16. Явелов И.С. Профилактика венозных тромбоэмболических осложнений у больных, госпитализированных с нехирургическими заболеваниями. Трудный пациент. 2012; 7 (10): 4-11.
17. Ягудина Р.И., Куликов А.Ю., Нгуен Т. Определение «порога готовности платить» в России, в Европейских странах и в странах СНГ. Современная фармакоэкономика и фармакоэпидемиология. 2011.; 4 (1): 7-13.
18. Alikhan R., Cohen A.T., Combe S. et al. Risk Factors for Venous Thromboembolism in Hospitalized Patients With Acute Medical Illness. Analysis of the MEDENOX Study. Arch Intern Med. 2004; 164: 963-968.
19. Avritscher E.B., Cantor S.B., Shih Y.C. et al. Cost-minimization analysis of low-molecular-weight heparin (dalteparin) compared to unfractionated heparin for inpatient treatment of cancer patients with deep venous thrombosis. Support Care Cancer. 2004; 12 (7): 531-6.
20. Bergqvist D., Burmark U.S., Frisell J. et al. Thromboprophylactic effect of low molecular weight heparin started in the evening before elective general abdominal surgery: a comparison with low-dose heparin. Semin. Thromb. Hemost. 1990; 16: 19-24.
21. Borstad E., Urdal K, Handeland G. et al. Comparison of low molecular weight heparin vs. Unfractionated heparin in gynecological surgery. Acta Obstet. Gynecol. Scand. 1988; 67 (2): 99-103.
22. Cohen A.T., Tapson V.F., Bergmann J.F. et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371: 387-94.
23. Carson W., Schilling B., Simons W.R. Comparative Effectiveness of Dalteparin and Enoxaparin in a Hospital Setting. Journal of Pharmacy Practice. 2012; 25: 180.
24. Cook D., Douketis J., Meade M. et al. Venous thromboembolism and bleeding in critically ill patients with severe renal insufficiency receiving dalteparin thromboprophylaxis: prevalence, incidence and risk factors. Crit Care. 2008;12 (2):R32.
25. Cook D.J., Douketis J., Arnold D. et al. Bleeding and venous thromboembolism in the critically ill with emphasis on patients with renal insufficiency. Curr. Opin. Pulm. Med. 2009; 15 (5): 455-62.
26. Douketis J., Cook D., Meade M. et al. Prophylaxis Against Deep Vein Thrombosis in Critically Ill Patients With Severe Renal Insufficiency With the Low-Molecular-Weight Heparin Dalteparin. An Assessment of Safety and Pharmacodynamics: The DIRECT Study. Arch. Intern. Med.2008; 168 (16): 1805-1812.
27. Dager W.E., Kiser T.H. Systemic anticoagulation considerations in chronic kidney disease. Adv. Chronic. Kidney Dis. 2010; 17 (5):420-7.
28. Dellinger R., Levy M., Rhodes A. et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock. 2012; Crit. Care. Med. 2013; 41 (2): 580-637.
29. Geerts W.H., Pineo G.F., Heit J.A., Bergqvist D. Prevention of venous thromboembolism: The Seventh ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2004; 126: 338-400.
30. Gould M.K., Garcia D.A., Wren S.M. et al. Clinical Practice Guidelines College of Chest Physicians Evidence-Based Prevention of Thrombosis, 9th ed: American Patients : Antithrombotic Therapy and Prevention of VTE in Nonorthopedic Surgical. Chest 2012; 141:e227S-e277S.
31. Graafsma Y.P., Prins M.H., Lensing A.W. et al. Bleeding classification in clinical trials: observer variability and clinical relevance. Thromb Haemost. 1997; 78 (4): 1189-1192.
32. G mez-Outes A., Rocha E., Mart nez-Gonz lez J. et al. Cost effectiveness of bemiparin sodium versus unfractionated heparin and oral anticoagulants in the acute and long-term treatment of deep vein thrombosis. Pharmacoeconomics. 2006; 24 (1): 81-92.
33. Gould M.K., Dembitzer A.D., Sanders G.D. et al. Low-molecularweight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A cost-effectiveness analysis. Ann. Intern. Med. 1999; 130 (10): 789-99.
34. Hoffmann P., Keller F. Increased major bleeding risk in patients with kidney dysfunction receiving enoxaparin: a meta-analysis. Eur J Clin Pharmacol. 2012; 68: 757-765.
35. Kanaan A.O., Silva M.A., Donovan J.L. et al. Meta-analysis of venous thromboembolism prophylaxis in medically Ill patients. Clin. Ther. 2007; 29: 2395-2405.
36. Khan N.A., Quan H., Bugar J.M. et al. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J. Gen. Intern. Med. 2006; 21 (2): 177-180.
37. Labropoulos N. Гемодинамические изменения и классификация СЕАР. Флеболимфология. 2004; 23: 2-6.
38. Leizorovicz A., Cohen A.T., Turpie A.G. et al. For the PREVENT Medical Thromboprophylaxis Study. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation. 2004; 110: 874-879.
39. Lachish T., Rudensky B., Slotki I. et al. Enoxaparin dosage adjustment in patients with severe renal failure: antifactor xa concentrations and safety. Pharmacotherapy. 2007; 27 (10): 1347-52.
40. Lim W., Dentali F., Eikelboom J.W., et al. Meta-analysis: lowmolecularweight heparin and bleeding in patients with severe renal insufficiency. Ann. Intern. Med. 2006; 144 (9): 673-84.
41. Lobo B.L. Use of newer anticoagulants in patients with chronic kidney disease. Am. J. Health. Syst. Pharm. 2007; 64 (19): 2017-26.
42. Lim W. Low-molecular-weight heparin in patients with chronic renal insufficiency. Intern Emerg Med. 2008; 3 (4): 319-23.
43. Pai M., Lloyd N.S., Cheng J. et al. Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trial. Implementation Science. 2013; 8: 1.
44. Robert-Ebadi H., Righini M. Use of anticoagulants in elderly patients: practical recommendations. Clin Interv Aging. 2009; 4: 165–177.
45. Schmida P., Fischerb A.G., Wuillemina W.A. Low-molecularweight heparin in patients with renal insufficiency. SWISS MED WKLY 2009; 139 (31-32): 438-452.
46. Spinler S.A., Inverso S.M., Cohen M., et al. Safety and efficacy of unfractionated heparin versus enoxaparin in patients who are obese and patients with severe renal impairment: analysis from the ESSENCE and TIMI 11B studies. American heart journal. 2003;146 (1): 33-41.
47. Tincani E., Mannucci C., Casolari B. et al. Safety of dalteparin for the prophylaxis of venous thromboembolism in elderly medical patients with renal insufficiency: a pilot study. Haematologica. 2006; 91: 976-9.
48. Trujillo-Santos J., Schellong S., Falga C. et al. Low-molecularweight or Unfractionated Heparin in Venous Thromboembolism: The Influence of Renal Function. Am. J. Med. 2013; (13): S0002-9343 00011-9.
49. Walley T., Haycox A., Boland A. Pharmacoeconomics. 2004. 216 с.
50. Weinstein M.C., O'Brien B., Hornberger J. et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices–Modeling Studies.Value Health. 2003; 6 (1): 9-17.
51. Wattanakit K., Cushman M., Stehman-Breen C. et al. Chronic kidney disease increases risk for venous thromboembolism. J. Am. Soc. Nephrol. 2008; 19 (1): 135-40.
52. Wilbur K., Lynd L.D., Sadatsafavi M. Low-molecular-weight heparin versus unfractionated heparin for prophylaxis of venous thromboembolism in medicine patients – a pharmacoeconomic analysis. Clin. Appl. Thromb. Hemost. 2011; 17: 454.
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For citations:
Kolbin A.S., Vilyum I.A., Proskurin M.A., Balykina Yu.E. Pharmacoeconomical analysis of use of the low-molecular weight heparins for prevention of the venous tromboembolism in the conditions of multidisciplinary hospital. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2013;6(4):26-34. (In Russ.)
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