左心耳封堵术对比华法林预防心房颤动患者血栓栓塞的卫生经济学评价

Cost-Utility Analysis of Left Atrial Appendage Closure(LAAC) compared with Warfarin to prevent thrombus in the treatment of Atrial Fibrillation in China

目的评价左心耳封堵术(WATCHMAN)对比华法林预防心房颤动患者血栓栓塞的经济性,为临床合理治疗、药费支付等相关决策提供参考。方法本研究采用回顾性研究设计,从付费者角度出发,基于左心耳封堵术相关随机对照临床试验数据,构建马尔科夫模型,采用成本-效用分析对左心耳封堵术对比华法林预防栓塞的经济性进行评价。结果左心耳封堵术组的卫生总成本为135 212.51元,而华法林组为40 961.06元,左心耳封堵术组治疗终生(30年)人均QALY值为9.640,华法林组终生(30年)人均QALY值为8.653,增量成本效果比(ICER)为95 488.51元/QALY,低于WHO推荐的3倍人均GDP(2015年)的阈值。敏感性分析证明研究结果具有稳定性。结论与华法林组相比,左心耳封堵术预防心房颤动患者血栓栓塞具有经济学优势。

Objective Conduct a Cost-Utility analysis of left atrial appendage closure（LAAC） device to prevent thrombus in the treatment of atrial fibrillation,compared with Warfarin,in China,to provide evidence for relevant medical decision making.Method A Markov model,from a payer perspective,was developed to predict 30-year total cost and QALYs gained for LAAC and warfarin groups.Results The total cost for the LAAC group was $135,212.51 while the total cost for the warfarin group was $40,961.06. The QALYs gained for the LAAC group were 9.640 while the total QALYs gained for the warfarin group was 8.653.The ICER was estimated to be $95,488.51/QALY which was below the ICER threshold of 3 times GDP per capita in China（2015） recommended by WHO.Conclusion Compared with warfarin, LAAC is a cost-effective alternative for preventing thrombus in the treatment of atrial fibrillation in China.