Kim Hyunmee, Kim Hyeongsoo, Cho Seong Kyung, Kim Jin Bae, Joung Boyoung, Kim Changsoo
Department of Preventive Medicine, Institute of Human Complexity and Systems Science, Yonsei University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Korean Circ J. 2019 Mar;49(3):252-263. doi: 10.4070/kcj.2018.0220. Epub 2018 Nov 14.
Rivaroxaban is noninferior to warfarin for preventing stroke or systemic embolism in patients with high-risk atrial fibrillation (AF) and is associated with a lower rate of intracranial hemorrhage (ICH). We assessed the cost-effectiveness of rivaroxaban compared to adjusted-dose warfarin for the prevention of stroke in patients with nonvalvular AF.
We built a Markov model using the Korean Health Insurance Review & Assessment Service database. The base-case analysis assumed a cohort of patients with prevalent AF who were aged 18 years or older without contraindications to anticoagulation.
Number of patients with CHA₂DS₂-VASc scores 0, 1 and ≥2 were 56 (0.2%), 1,944 (6.3%) and 28,650 (93.5%), respectively. In patients with CHA₂DS₂-VASc scores ≥2, the incidence rate of ischemic stroke was 3.11% and 3.76% in warfarin and rivaroxaban groups, respectively. The incidence rates of ICH were 0.42% and 0.15%, and those of gastrointestinal bleeding were 0.32% and 0.15% in warfarin and rivaroxaban, respectively. Patients with AF treated with rivaroxaban lived an average of 11.8 quality-adjusted life years (QALYs) at a lifetime treatment cost of $20,886. Those receiving warfarin lived an average of 11.4 QALYs and incurred costs of $17,151. Patients with rivaroxaban gained an additional 0.4 QALYs over a lifetime with an additional cost of $3,735, resulting in an incremental cost-effectiveness ratio of $9,707 per QALY.
Patients who had been treated with rivaroxaban may be a cost-effective alternative to warfarin for stroke prevention in Korean patients with AF.
在预防高危心房颤动（AF）患者发生卒中或全身性栓塞方面，利伐沙班不劣于华法林，且颅内出血（ICH）发生率较低。我们评估了利伐沙班与调整剂量华法林相比，在预防非瓣膜性AF患者卒中方面的成本效益。
我们使用韩国健康保险审查与评估服务数据库构建了一个马尔可夫模型。基础病例分析假设为一组患有AF的患者，年龄在18岁及以上，且无抗凝治疗禁忌证。
CHA₂DS₂-VASc评分分别为0、1和≥2的患者数量分别为56例（0.2%）、1944例（6.3%）和28650例（93.5%）。在CHA₂DS₂-VASc评分≥2的患者中，华法林组和利伐沙班组的缺血性卒中发生率分别为3.11%和3.76%。华法林组和利伐沙班组的ICH发生率分别为0.42%和0.15%，胃肠道出血发生率分别为0.32%和0.15%。接受利伐沙班治疗的AF患者一生治疗成本为20886美元，平均获得11.8个质量调整生命年（QALY）。接受华法林治疗的患者平均获得11.4个QALY，费用为17151美元。利伐沙班治疗的患者一生多获得0.4个QALY，但额外费用为3735美元，增量成本效益比为每QALY 9707美元。
对于韩国AF患者，利伐沙班治疗可能是一种在预防卒中方面成本效益优于华法林的替代方案。
