新型抗凝药与华法林用于非瓣膜性房颤患者卒中防治的成本效果分析

发布时间：2018-01-30 05:30

本文关键词： 新型口服抗凝药华法林非瓣膜性房颤抗凝药物经济学　出处：《中国医院药学杂志》2016年12期 　论文类型：期刊论文

【摘要】：目的:评估中国非瓣膜性房颤患者使用新型抗凝药预防卒中的成本效果,为中国房颤患者抗凝治疗药物的合理选用提供理论依据。方法:基于全球性临床试验ARISTOTLE、RE-LY及ROCKET-AF的研究数据及我国目前医疗成本,建立一年期决策树及长期外推Markov模型的方法,通过分别计算3种新型口服抗凝药物阿哌沙班(5 mg bid)、达比加群(150 mg bid、110 mg bid)、利伐沙班(20 mg qd)和华法林的调整质量生命年(QLAYs)及治疗成本,对新型抗凝药物用于中国房颤患者卒中预防的成本效果进行了分析和研究。结果:NOACs治疗的总成本为163 586~582 710元,使用NOACs患者可获得的质量调整生命年为6.812~7.010。以华法林为参考的增效成本效果分析显示,成本效果比(ICER)为177 271~739 480元/QLAY,ICER_(利伐沙班)ICER_(阿哌沙班)ICER_(达比加群150 mg)ICER_(达比加群110 mg)。3种抗凝药物与华法林比较的ICER均大于我国人均国民生产总值(GDP)的3倍,但小于部分城市人均GDP的3倍。一维敏感度分析显示该成本效果分析结果稳定可靠。结论:目前在我国,与华法林相比,使用新型抗凝药物预防非瓣膜性房颤患者卒中不具备成本效果优势。目前仅在我国经济发达的某些城市,可推荐阿哌沙班或达比加群用于房颤卒中的治疗。
[Abstract]:Objective: to evaluate the cost-effectiveness of using new anticoagulants in patients with non-valvular atrial fibrillation in China. To provide a theoretical basis for the rational selection of anticoagulant drugs in patients with atrial fibrillation in China. Methods: based on the global clinical trial ARISTOTLE. The research data of RE-LY and ROCKET-AF and the current medical cost in China, the method of establishing the one-year decision tree and long-term extrapolation Markov model. The three new oral anticoagulant drugs, Apiprazamil (5 mg) and Darby (150 mg (bid) (110 mg), respectively) were calculated. The adjusted quality of life years (QLAYs) and the cost of treatment of rivastaben 20 mg QD) and warfarin. The cost effectiveness of new anticoagulants for stroke prevention in patients with atrial fibrillation in China was analyzed and studied. Results the total cost of the treatment was 163,586n 582,710 yuan. The QLYs available for patients with NOACs were 6.812 / 7.010. A cost-benefit analysis using warfarin as a reference showed. Cost-effectiveness ratio (ICER) was 177,271 / 739,480 yuan / QLAY. ICERS (150 mg of Darbica and 110mg of Darby). The ICER of anticoagulant drugs compared with warfarin was 3 times higher than that of GDP per capita in China. But it is less than 3 times of GDP per capita in some cities. One-dimensional sensitivity analysis shows that the cost-effect analysis results are stable and reliable. Conclusion: at present, compared with warfarin in China. The use of new anticoagulants for the prevention of stroke in patients with non-valvular atrial fibrillation does not have the advantage of cost effectiveness. At present, in some economically developed cities in China, it is recommended that piperazaban or Dabigan be used in the treatment of atrial fibrillation stroke.
【作者单位】：武汉大学人民医院药学部;
【基金】：湖北省自然科学基金(青年)项目(编号:2015CFB334)
【分类号】：R541.75;R743.3
【正文快照】： 脑卒中是指由于脑部血管突然破裂或因血管阻塞造成血液循环障碍而引起脑组织损伤的一种疾病。报道统计我国每年新发卒中病例多达250万人[1]。在卒中的众多危险因素中,心房颤动(房颤)是其独立的危险因子。目前的研究结果显示,我国住院房颤患者的脑卒中发生率达24.8%,且发生卒中

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