新型口服抗凝药预防房颤患者卒中的经济学评价

Economic Evaluation of New Oral Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation

目的 采用马尔可夫模型评价达比加群酯、利伐沙班、阿哌沙班和艾多沙班4种口服抗凝药对比华法林在现实世界预防中国非瓣膜性房颤患者卒中的经济性。方法 从中国卫生体系的角度出发,1项真实世界研究提供了亚洲非瓣膜性心房颤动患者使用4种新型口服抗凝药高低剂量有效性和安全性数据,并分别与华法林进行了比较。模型周期为3个月,研究时限20年。分析模型得出的结果以及比较增量成本-效果比与意愿支付阈值,并进行了敏感性分析。结果 在基线分析中,与华法林相比,4种新型口服抗凝药中低剂量的艾多沙班增量成本效果比最低约为3万元/QALY,阿哌沙班5 mg获得的质量调整生命年最高。增量成本分析结果显示,除了阿哌沙班的两种剂量之外,其余6种治疗方案相较于华法林的ICER均小于意愿支付阈值。敏感性分析证实了基本分析结果的稳健性。结论 从中国卫生系统角度出发,当意愿支付阈值为257 100元时,除了阿哌沙班外,利伐沙班、达比加群和艾多沙班均是具有经济学优势的治疗方案。

OBJECTIVEA Markov model was used to evaluate the economics of four oral anticoagulants,dabigatran,rivaroxaban,apixaban and edoxaban,compared with warfarin for real-world stroke prevention in Chinese patients with nonvalvular atrial fibrllation.METHODS From the perspective of the Chinese health system,a real-world study provided high-dose and low-dose efficacy and safety data of 4 new oral anticoagulants in Asian patients with nonvalvular atrial fibrllation and compared them separately with warfarin.The modelling period was 3 months and the time horizon was 20 years.The results derived from the model were analyzed as well as comparing incremental cost-effectiveness ratios with willingness-to-pay thresholds,and sensitivity analyses were performed.RESULTS In base case analysis,the lowest incremental cost-effectiveness ratio of approximately 30,000 yuan/Quality-Adjusted Life Year(QALY)was obtained for low-dose edoxaban and the highest QALY was obtained for apixaban 5 mg among the 4 new oral anticoagulants compared with warfarin.The results of the incremental cost analysis showed that,with the exception of the two doses of apixaban,the ICERs of the remaining six treatment options compared with warfarin were less than the willingness-to-pay threshold.Sensitivity analyses confirmed the robustness of the basic analysis results.CONCLUSION From the perspective of the Chinese health system,when considering a willingness-to-pay threshold of 257100 yuan,rivaroxaban,dabigatran,and edoxaban,in addition to apixaban,are economically advantageous treatment options.