达比加群和利伐沙班及华法林预防心房颤动并发脑卒中的经济学评价

Economic evaluation of dabigatran,rivaroxaban and warfarin in preventing stroke in patients with atrial fibrillation

目的:评价在中国采用达比加群、利伐沙班和华法林3种抗凝血药物预防心房颤动患者并发脑卒中的经济性。方法:根据疾病自然史构建心房颤动Markov模型,预测不同治疗方案下患者获得的质量调整生命年(quality adjusted life year,QALY)和花费的成本,并对结果进行成本效果分析。模型周期为3个月,研究时限30年。对多种因素进行了单因素敏感性和概率敏感性分析。结果:基线分析中,达比加群组和利伐沙班组相较于华法林组分别多获得0.38 QALYs和0.15 QALYs,同时多花费成本137 181.31元和351 514.95元,增量成本效果比分别为361 003.45和2 343 433。结论:在WTP为139 885.5元时,华法林具有经济学优势。

Objective： To evaluate the cost-effectiveness of dabigatran,rivaroxaban and warfarin in preventing stroke in patients with atrial fibrillation in China from the health care system perspective. Methods： Based on natural history of disease,an atrial fibrillation Markov model was constructed to simulate the quality adjusted life years（ QALY） and costs in patients with atrial fibrillation under different treatments. A 3 months cycle length and 30 years horizon were adopted. One way deterministic and probabilistic sensitivity analyses were conducted to explore the uncertainties from a number of variables and model assumptions. Results： In the baseline analysis,patients in dabigatran group and rivaroxaban group obtained 0. 38 QALYs and 0. 15 QALYs more than patients in warfarin group respectively,while incurring $ 137 181. 31 and $ 351 514. 95 more costs than warfarin group. The incremental cost per QALY gained for dabigatran versus warfarin was $ 361 003. 45 and $ 2 343 433,rivaroxaban was dominated by dabigatran. Conclusion： Warfarin is considered to be cost-effective at the WTP of $ 139 885. 5 / QALY.