Department of Clinical Pharmacy and Toxicology, Martini Hospital, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands.
Unit of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
Eur J Health Econ. 2018 Sep;19(7):957-965. doi: 10.1007/s10198-017-0942-2. Epub 2017 Nov 27.
Electrical cardioversion (ECV) is a procedure in which a direct current electric shock is used to quickly and effectively restore the normal sinus rhythm. Appropriate anticoagulation reduces the risk of embolic events during and after ECV. The aim of this study was to estimate the cost-effectiveness of rivaroxaban compared with vitamin K oral antagonists (VKAs) in patients with atrial fibrillation undergoing elective ECV in the Netherlands.
A static transmission model over a 1-year time horizon was developed to compare rivaroxaban with VKAs in terms of clinical outcomes, health effects (quality-adjusted life years; QALYs), and costs. Cost-effectiveness was assessed from a societal and health care payer perspective at a willingness-to-pay level of €20,000 per QALY gained. The use of rivaroxaban as an anticoagulant in patients with atrial fibrillation scheduled for ECV would lead to a health gain of 0.23 QALYs per patient and would cost €1.83 per patient from the societal perspective, resulting in an incremental cost-effectiveness ratio of €7.92 per QALY gained. The probability of rivaroxaban being cost-saving compared with VKAs was 49.6% from this perspective. From the health care payer perspective, the incremental cost would be €509 per patient with a health gain of 0.23 QALYs per patient, resulting in an incremental cost-effectiveness ratio of €2198 per QALY gained.
The use of rivaroxaban in elective ECV is a cost-effective alternative to the use of VKAs. Rivaroxaban has a 50% probability of being cost-saving compared with VKAs and would increase a patient's quality of life when non-health care costs such as productivity loss and informal care costs are taken into account.
电复律（ECV）是一种使用直流电电击来快速有效地恢复正常窦性节律的程序。适当的抗凝治疗可降低 ECV 期间和之后发生栓塞事件的风险。本研究旨在评估利伐沙班与维生素 K 口服拮抗剂（VKAs）在荷兰接受择期 ECV 的心房颤动患者中的成本效益。
在 1 年的时间内，建立了一个静态传输模型，以比较利伐沙班与 VKAs 在临床结局、健康效果（质量调整生命年；QALYs）和成本方面的情况。从社会和医疗保健支付者的角度，以每获得 1 个 QALY 支付 20000 欧元的意愿支付水平来评估成本效益。在计划接受 ECV 的心房颤动患者中，使用利伐沙班作为抗凝剂将使每位患者的健康状况提高 0.23 个 QALY，从社会角度来看，每位患者的成本为 1.83 欧元，增量成本效益比为每获得 1 个 QALY 增加 7.92 欧元。从这个角度来看，利伐沙班比 VKAs 更有可能节省成本的概率为 49.6%。从医疗保健支付者的角度来看，每增加 0.23 个 QALY 的成本为每位患者 509 欧元，增量成本效益比为每获得 1 个 QALY 增加 2198 欧元。
在择期 ECV 中使用利伐沙班是替代 VKAs 的一种具有成本效益的选择。与 VKAs 相比，利伐沙班有 50%的可能性节省成本，并会提高患者的生活质量，当考虑非医疗保健成本（如生产力损失和非正式护理成本）时。
