1 College of Pharmacy, Qatar University, Doha, Qatar.
Clin Appl Thromb Hemost. 2019 Jan-Dec;25:1076029619849103. doi: 10.1177/1076029619849103.
Venous thromboembolism (VTE) is associated with high recurrence, mortality, and cost burden. Direct oral anticoagulants (DOACs) are currently used for VTE treatment, and they offer more benefits over warfarin, despite being more expensive. There is no consensus on the most cost-effective DOAC agent, especially in VTE. This systematic review aims to summarize the comparative cost-effectiveness studies and their impact among DOACs in the treatment of VTE. Literature systematic review of PubMed, Embase, and EconLit was conducted in February 2018 to identify all cost-effectiveness studies of DOAC for the treatment and prevention of VTE. Two independent investigators systematically collected search results and assessed the quality of the studies. The search identified 7 articles, all of which had dabigatran and rivaroxaban as comparators, 6 of which also included apixaban, and 2 of which also had edoxaban. Results of 3 articles concluded that apixaban is a dominant strategy compared to other DOACs in terms of Incremental Cost-Effectiveness Ratio (ICER) in the treatment and prevention of recurrent VTE. One article compared rivaroxaban and dabigatran, with the latter dominating rivaroxaban in terms of ICER. Compared to other DOACs, 2 articles reported apixaban being associated with highest annual total medical cost avoidance of US$4244 and US$4440 per patient-year (ppy), respectively. One article reported that apixaban had the highest annual total medical cost differences of US$918 ppy compared to other DOACs. This systematic review demonstrates that apixaban is considered a cost-effective strategy for VTE treatment and prevention of recurrent VTE.
静脉血栓栓塞症（VTE）与高复发率、高死亡率和高经济负担相关。直接口服抗凝剂（DOAC）目前被用于 VTE 的治疗，尽管价格更高，但与华法林相比，具有更多的优势。目前尚未达成最具成本效益的 DOAC 药物共识，尤其是在 VTE 治疗方面。本系统评价旨在总结 DOAC 治疗 VTE 的成本效益比较研究及其影响。2018 年 2 月，我们通过对 PubMed、Embase 和 EconLit 进行文献系统评价，以确定所有 DOAC 治疗和预防 VTE 的成本效益研究。两名独立的调查员系统地收集了检索结果并评估了研究的质量。检索共确定了 7 篇文章，均将达比加群和利伐沙班作为对照药物，其中 6 篇还纳入了阿哌沙班，2 篇还纳入了依度沙班。有 3 篇文章的结果表明，在治疗和预防复发性 VTE 方面，阿哌沙班的增量成本效果比（ICER）较其他 DOAC 更具优势。有 1 篇文章比较了利伐沙班和达比加群，后者的 ICER 优于利伐沙班。与其他 DOAC 相比，有 2 篇文章分别报道阿哌沙班可避免每位患者每年 4244 美元和 4440 美元的年度总医疗成本，阿哌沙班具有最高的年度总医疗成本节约优势。有 1 篇文章报道，与其他 DOAC 相比，阿哌沙班的年度总医疗成本差异为 918 美元。本系统评价表明，阿哌沙班被认为是治疗 VTE 和预防复发性 VTE 的一种具有成本效益的策略。
