<International Circulation>: When would you not use the novel anticoagulants?
   《国际循环》：您什么时候会应用新的抗凝药物呢？
    Prof. Weitz: It would be that they are expensive.  If patients don’t have insurance coverage they may not be able to afford the novel agents.  We are seeing that already that for prophylaxis after orthopedic surgery， such as knee or hip replacement surgery， we routinely use Riverox for 14 days to one month.  The administration is much simpler in that patients just take one pill per day and don’t need to do injections.  Some patients just can’t afford it. 
    Weitz教授:他们都很贵。如果患者没有保险，他们就买不起这类新药。我们已经看到骨科手术，如膝关节或髋关节置换术后，预防性得使用抗凝药物，一般常规予以Riverox14天到一个月。处置很简单，一天一丸药，一天一次，不需要注射。一些患者时买不起的。
 
    <International Circulation>: If it has to be injected and monitored， how much cheaper is it?  Also， it seems that after a hip replacement how much the price would really matter.
   《国际循环》：如果不得不注射和监测的话，它会多便宜？还有，髋关节置换术后价格多少才真正重要？

    Prof. Weitz: But we don’t monitor low molecular weight heparin.  The price is about ＄10 per day or ＄300 per month for the novel anticoagulant.  In Canada we have a healthcare system that pays for the surgery while patients under 65 without an independent drug plan are responsible for their own medicine.  It would be country specific.  What will likely happen though is that the cost of these agents will reduce as more come to market.  For short-term use the novel agents may even be cheaper than for low molecular weight heparin.  Warfarin is very cheap， costing only about ＄0.12 per day but does require monitoring.  Because of silo-financing we don’t often count the cost of monitoring or the costs of an elderly person going to the coagulation lab for phlebotomy， the family member who may have to take time away from work to do that are not considered.  These factors are outside of pure drug efficacy but nevertheless are part of a patient’s decision.  In general， the drugs are more similar than they are dissimilar， they each have pros and cons.  Overall， we can see a class effect for all of them with just a few differentiating factors that may make one drug a little better than another in different circumstances.

    Weitz教授: 但是我们不监测低分子肝素。新型抗凝药物的价格大约是每天＄10或＄300每月。在加拿大，我们有一个为外科手术买单的医疗制度。该制度针对的是65岁以下的患者，不是单一药物治疗，自己掏钱买药。当然，每个国家情况不同。随着这些药物进入市场，成本降低，将来可能发生什么事情。作为短期使用的新药，他们可能甚至 比低分子肝素便宜。华法林非常便宜，每天仅花费＄0.12，但是需要监测。由于简仓融资，我们不经常计算监测或老年人取凝血化验室的静脉抽血的费用以及占用的家属的工作时间产生的费用，我们都必须考虑。这些因素在单纯的药物疗效之外，尽管如此，仍是患者治疗选择的部分原因。一般来说，这类药物相似点较点不同多，他们各有利弊。总的来说，我们可以看到一类药物的疗效，彼此之间稍有少许不同，这也是可能造成他们在不同的环境或条件下比别的药物好一点的原因。

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