摘要
目的从中国的支付者角度,对达比加群和华法林预防房颤相关的脑卒中进行药物经济学评价,为中国房颤患者抗凝治疗的选择提供依据。方法构建了一个个体水平模拟模型,预测不同治疗方案下随时间所经历的临床事件及其结果(临床效果、期望寿命、质量调整生命年及成本),并对所比较药物进行成本-效果分析,对分析结果进行一维敏感性分析。各治疗的有效性和安全性数据来源于RE-LY试验和已发表中外文献,以及相关临床专家意见。结果相比华法林治疗,达比加群治疗降低了多数临床事件的发生,如缺血性卒中降低0.63/100人年,出血性卒中降低0.18/100人年,脑内出血降低0.32/100人年,系统性栓塞降低0.10/100人年,短暂缺血性发作降低0.56/100人年,但脑外出血却升高0.75/100人年,急性心肌梗死升高0.24/100人年。华法林治疗与达比加群治疗所需的总成本分别为$35732和$109305,所获得的健康效果分别6.98QALY和7.18QALY;达比加群与华法林比较的ICER为$375291/QALY。结论在WTP为$115261/QALY时,华法林治疗更具有成本效果。达比加群在中国的经济学评价有待进一步研究。
Objective To evaluate the potential cost-effectiveness of dabigatran for the prevention of stroke and systemic embolism among patients with AF as compared to warfarin as a first-line therapy ,from the payer perspective in China. Methods An individual level simulation model was developed to simulate the clinical events and outcomes under different treatment pathways over a patient＇ s remaining lifetime. Input data were derived from the published literature and expert inputs. One way sensitivity analysis was used to test the stability of the results and identify key variables. Results Comparing to warfarin firstline use among patients eligible for anticoagulants, dabigatran was associated with 0. 63 fewer ischemic stroke,0.18 fewer hem- orrhagic stroke,0. 32 fewer intracranial hemorrhage, 0. 10 fewer systemic embolism,0. 56 fewer transient ischemic attack, 0. 75 more extra-cranial hemorrhage and 0. 24 more acute myocardial infarction, per 100 patient-year. Total discounted lifetime costs for warfarin and dabigatran were ￥35732. 48 and g109305.21, total QALYs were 6. 98 and 7. 18, resulting an ICER of ~ 375291.35 per QALY gained. The result was sensitive to dabigatran cost, INR control assumptions, cycle length and time horizon. Conclusion Warfarin was considered to be cost-effective at the WTP of ￥ 115261/QALY. Further economic evaluation of appropriate use of dabigatran in China setting is needed.
出处
《中国卫生统计》
CSCD
北大核心
2014年第4期608-611,共4页
Chinese Journal of Health Statistics
关键词
心房颤动
脑卒中预防
药物经济学评价
成本效果分析
Atrial fibrillation
Stroke prevention
Economic evaluation
Cost-effectiveness analysis
