Verhoef Talitha I, Redekop William K, Hasrat Fazila, de Boer Anthonius, Maitland-van der Zee Anke Hilse
Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, P. O. Box 80 082, 3508 TB, Utrecht, The Netherlands,
Am J Cardiovasc Drugs. 2014 Dec;14(6):451-62. doi: 10.1007/s40256-014-0092-1.
Our objectives were to investigate the cost effectiveness of apixaban, rivaroxaban, and dabigatran compared with coumarin derivatives for stroke prevention in patients with atrial fibrillation in a country with specialized anticoagulation clinics (the Netherlands) and in a country without these clinics (the UK).
A decision-analytic Markov model was used to analyse the cost effectiveness of apixaban, rivaroxaban, and dabigatran compared with coumarin derivatives in the Netherlands and the UK over a lifetime horizon.
In the Netherlands, the use of rivaroxaban, apixaban, or dabigatran increased health by 0.166, 0.365, and 0.374 quality-adjusted life-years (QALYs) compared with coumarin derivatives, but also increased costs by
Apixaban, rivaroxaban, and dabigatran are cost-effective alternatives to coumarin derivatives in the UK, while in the Netherlands, only apixaban and dabigatran could be considered cost effective. The cost effectiveness of the new oral anticoagulants is largely dependent on the setting and quality of local anticoagulant care facilities.
我们的目的是在一个设有专业抗凝门诊的国家（荷兰）和一个没有这些门诊的国家（英国），研究阿哌沙班、利伐沙班和达比加群与香豆素衍生物相比，在预防房颤患者中风方面的成本效益。
采用决策分析马尔可夫模型，分析在荷兰和英国，阿哌沙班、利伐沙班和达比加群与香豆素衍生物相比在整个生命周期内的成本效益。
在荷兰，与香豆素衍生物相比，使用利伐沙班、阿哌沙班或达比加群分别使健康状况改善了0.166、0.365和0.374个质量调整生命年（QALY），但成本也分别增加了5681欧元、4754欧元和5465欧元。每获得一个QALY的增量成本效益比（ICER）分别为34248欧元、13024欧元和14626欧元。在英国，健康状况改善了0.302、0.455和0.461个QALY，三种新型口服抗凝剂的增量成本相似（5118 - 5217欧元）。每获得一个QALY的ICER在11172欧元至16949欧元之间。在荷兰，在成本效益阈值为20000欧元时，阿哌沙班具有最高的成本效益机会（%）；在英国，达比加群的这一机会为41%。治疗范围内的时间所反映的护理质量对ICER有重要影响。
在英国，阿哌沙班、利伐沙班和达比加群是香豆素衍生物具有成本效益的替代药物，而在荷兰，只有阿哌沙班和达比加群可被认为具有成本效益。新型口服抗凝剂的成本效益在很大程度上取决于当地抗凝护理设施的环境和质量。
