国内上市新型口服抗凝药预防非瓣膜性房颤卒中药物经济学研究系统评价

Pharmacoeconomics of Domestic Commercial Novel Oral Anticoagulants for Preventing Non-Valvular Atrial Fibrillation and Stroke:A Systematic Review

目的系统评价国内上市新型口服抗凝药(NOAC)预防非瓣膜性房颤(NVAF)卒中的经济性。方法计算机检索PubMed,Embase,The Cochrane Library数据库,以及中国知网(CNKI)、万方(WanFang)数据库、维普(VIP)数据库,收集使用国内上市的NOAC(利伐沙班、阿哌沙班、达比加群)和华法林预防NVAF卒中的经济学评价研究,检索时限为各数据库自建库起至2021年11月30日。由2名研究者根据标准独立筛选文献,并分别采用卫生经济评估报告综合标准(CHEERS)评估纳入文献的质量;描述性方法总结纳入文献的基本特征,归纳其经济学评价结果。结果共纳入10项研究,均为中国环境下的成本-效果或成本-效用研究、并经质量评价均有一定参考价值(得分>75%)。2014年至2019年的7项研究结果均显示,NOAC与华法林比较无成本-效果优势,而2021年的2项研究结果则显示NOAC比华法林更具有成本-效果优势。其中1项对比研究结果显示达比加群的成本-效果优于利伐沙班,更具有经济学优势。结论NOAC预防NVAF卒中可能比华法林更具有成本-效果优势。

Objective To systematically evaluate the economy of domestic commercial novel oral anticoagulants(NOAC)for preventing non-valvular atrial fibrillation(NVAF)and stroke.Methods The PubMed,Embase,The Cochrane Library databases,CNKI,WanFang and VIP databases were searched to collect the economic evaluation studies on the prevention of NVAF and stroke with domestic commercial NOAC(rivaroxaban,apixaban,dabigatran)and warfarin from the inception of each database to November 30,2021.According to the criteria,the studies were screened independently by two researchers,and their quality was evaluated by the Consolidated Health Economic Evaluation Reporting Standards(CHEERS).The basic characteristics and the economic evaluation results of the included studies were summarized by the descriptive method.Results A total of 10 studies were included,all of which were cost-effectiveness or cost-utility studies in the Chinese context,and all of them had a certain reference value after quality evaluation(points>75%).Seven studies from 2014 to 2019 showed that NOAC had no cost-effectiveness advantage compared with warfarin,while two studies in 2021 showed that NOAC had more cost-effectiveness advantages than warfarin.A comparative study showed that dabigatran had more cost-effectiveness and economic advantages than rivaroxaban.Conclusion NOAC may have more cost-effectiveness advantage than warfarin in the prevention of NVAF and stroke.