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Coste-efectividad del Rivaroxabán frente a Dalteparina para prevención de trombosis recurrente en el paciente con cáncer

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dc.contributor.advisorMartínez del Valle, Anacaona
dc.creatorYate Cruz, José Alexander
dc.creatorPuentes Díaz, Andrea Liliana
dc.creator.degreeEspecialista en Epidemiología (en Convenio con el CES)spa
dc.creator.degreetypeFull timespa
dc.date.accessioned2019-09-30T18:52:20Z
dc.date.available2019-09-30T18:52:20Z
dc.date.created2019-09-19
dc.descriptionIntroducción: En Colombia, el 90,9% de los pacientes con cáncer y eventos trombóticos se manejan con heparinas de bajo peso molecular, el 9,1% de los pacientes tiene irregular o mala adherencia. Rivaroxabán, un nuevo anticoagulante oral ha mostrado menor recurrencia de trombosis venosa y mejor adherencia en ensayos clínicos controlados en pacientes con cáncer, sin embargo, los pacientes tratados con Rivaroxabán han presentado mayor riesgo de sangrado. Objetivo: Realizar un análisis de coste-efectividad sobre el uso de rivaroxabán frente a dalteparina para la prevención de trombosis recurrente en pacientes con cáncer. Materiales y métodos: El análisis de coste-efectividad se ha diseñado mediante un modelo farmacoeconómico, tomando como unidad de efectividad cada año de vida ganado por el tratamiento con rivaroxabán o dalteparina. La probabilidad de que aparezcan los desenlaces de interés se ha tomado de un ensayo clínico controlado que evalúa eficacia y seguridad de las dos intervenciones. Los costes valorados incluyen: el diagnóstico y tratamiento de los eventos de efectividad y seguridad. No se contemplan otros costos. La perspectiva del estudio es la del Sistema General de Seguridad Social Integral Colombiano y el horizonte temporal elegido para el análisis es 6 meses. Resultados: Se analizó una cohorte hipotética de 10.000 pacientes en cada intervención. No hubo diferencia entre las intervenciones en los años de vida ganados (10,8 años de vida ganados). La cohorte de pacientes con Rivaroxabán presentó menos eventos trombóticos (3,94 vs 8,86%) y más episodios de sangrado (sangrado mayor 5,42% vs 2,95% y sangrado menor 12,3% vs 3,45%) El costo de 6 meses de tratamiento en la cohorte con Rivaroxabán es de COP 40.844’290.368 y el de Dalteparina es de COP 59.252’261.591. El análisis de sensibilidad evidenció que a pesar de un aumento del 10% en el costo de rivaroxabán y una disminución del 10% del costo de la dalteparina, rivaroxabán sigue siendo la opción más costoefectiva. Restringir el rivaroxabán en pacientes con neoplasia gastroesofágica incrementa la diferencia de costos en un 62% a favor del tratamiento oral. Conclusiones: Rivaroxabán puede ser considerado una opción costo-efectiva para el tratamiento del tromboembolismo venoso en pacientes con cáncer ya que reduce costos cuando se compara con dalteparina. La seguridad del rivaroxabán aumenta con el uso discrecional en pacientes con patología urinaria y exclusión del paciente con cáncer esofágico y gastroesofágico.spa
dc.description.abstractIntroduction: In Colombia, 90.9% of patients with cancer and thrombotic events are treated with low molecular weight heparins, 9.1% of patients have irregular or poor treatment adhesion. Rivaroxabán, a new oral anticoagulant, has shown less recurrence of venous thrombosis and better adherence in controlled clinical trials in cancer patients; however, the patients treated with Rivaroxabán have presented a higher risk of bleeding. Objective: To perform a cost-effectiveness analysis about the use of rivaroxabán versus dalteparin for the prevention of recurrent thrombosis in cancer patients. Methods: The cost-effectiveness analysis has been designed using a pharmacoeconomic model, taking each year of life gained by the treatment with rivaroxabán or dalteparin as the unit of effectiveness. The probability that the outcomes of interest appear have been taken from a controlled clinical trial that evaluates the efficacy and safety of both interventions. The assessed costs include: the diagnosis and treatment of the effectiveness and safety events. No other costs are contemplated. The perspective of the study is that of the Social Security General System in Health of Colombia and the time horizon chosen for the analysis is 6 months. Results: A hypothetical cohort of 10,000 patients was analyzed in each intervention. There was no difference between the interventions in the years of life gained (10.8 years of life gained). The cohort of patients with Rivaroxabán had fewer thrombotic events (3.94 vs. 8.86%) and more bleeding episodes (major bleeding 5.42% vs. 2.95% and minor bleeding 12.3% vs. 3.45%) The cost of 6 months of treatment in the cohort with Rivaroxabán is COP 40,844'290,368 and in the cohort with Dalteparina is COP 59,252'261,591. The sensitivity analysis showed that despite a 10% increase in the cost of rivaroxabán and a 10% decrease in the cost of dalteparin, rivaroxabán remains the most cost-effective option. Restricting rivaroxabán in patients with gastroesophageal neoplasia increases the cost difference by 62% in favor of oral treatment. Conclusions: Rivaroxabán can be considered a cost-effective option for the treatment of venous thromboembolism in cancer patients since it reduces costs when compared with dalteparin. The safety of rivaroxabán increases with discretionary use in patients with urinary pathology and exclusion of the patient with esophageal and gastroesophageal cancer.spa
dc.description.embargo2019-09-30 13:55:01: Script de automatizacion de embargos. "30 sep 2019 El autor selecciona el tipo de acceso restringido, se asigna embargo por dos años. Se le envía correo 30 sep 2019 infrmandole el tiempo de embargo del documento."
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dc.identifier.doihttps://doi.org/10.48713/10336_20367
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/20367
dc.language.isospaspa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de medicinaspa
dc.rightsAtribución-NoComercial-SinDerivadas 2.5 Colombiaspa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectRivaroxabánspa
dc.subjectDalteparinaspa
dc.subjectCáncerspa
dc.subjectTromboembolismospa
dc.subjectFarmacoeconomíaspa
dc.subject.ddcCiencias médicas, Medicinaspa
dc.subject.keywordRivaroxabánspa
dc.subject.keywordDalteparinspa
dc.subject.keywordCancerspa
dc.subject.keywordThromboembolismspa
dc.subject.keywordPharmacoeconomicsspa
dc.subject.lembMedicinaspa
dc.subject.lembEpidemiologíaspa
dc.titleCoste-efectividad del Rivaroxabán frente a Dalteparina para prevención de trombosis recurrente en el paciente con cáncerspa
dc.typebachelorThesiseng
dc.type.documentTrabajo de gradospa
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de gradospa
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