Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan.
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Cardiovasc Drugs Ther. 2021 Jun;35(3):539-547. doi: 10.1007/s10557-020-07059-w. Epub 2020 Sep 10.
This study aimed to investigate the cost-effectiveness of low-dose rivaroxaban plus aspirin versus aspirin alone for patients with stable cardiovascular diseases in the Taiwan setting.
We constructed a Markov model to project the lifetime direct medical costs and quality-adjusted life-years of both therapies. Transitional probabilities were derived from the COMPASS trial, and the costs and utilities were obtained from the Taiwan National Health Insurance Database and published studies. One-way, scenario, subgroup, and probabilistic sensitivity analyses were performed to assess the uncertainty. Incremental cost-effectiveness ratio was presented as the outcome. The threshold of willingness-to-pay was set at US$76,368 (3 times the gross domestic product per capita of Taiwan). All analyses were operated by TreeAge 2019 and Microsoft Excel.
The incremental cost-effectiveness ratios of rivaroxaban plus aspirin versus aspirin alone in the patients with stable cardiovascular diseases, coronary artery diseases, and peripheral artery diseases were US$83,459, US$69,852 and -US$13,823 per quality-adjusted life-year gained, respectively. The probabilistic sensitivity analyses showed that the probabilities of cost-effectiveness for the regimen with rivaroxaban among those with cardiovascular diseases and coronary artery diseases were 44.1% and 65.3% at US$76,368.
Low-dose rivaroxaban plus aspirin is less likely to be a cost-effective alternative to aspirin in secondary prevention for the patients with stable cardiovascular diseases; however, among these patients, the regimen may have pharmacoeconomic incentives for the group merely having chronic coronary artery diseases from the Taiwan national payer's perspective. The pharmacoeconomic incentives are influenced by the drug price, event treatment fees, and willingness-to-pay threshold.
本研究旨在探讨在台湾地区，对于稳定型心血管疾病患者，低剂量利伐沙班加阿司匹林与单独使用阿司匹林相比的成本效益。
我们构建了一个马尔可夫模型，以预测两种治疗方案的终生直接医疗成本和质量调整生命年。转移概率来自 COMPASS 试验，成本和效用来自台湾全民健康保险数据库和已发表的研究。进行了单因素、情景、亚组和概率敏感性分析，以评估不确定性。增量成本效益比为结果。意愿支付的阈值设定为 76368 美元（台湾人均国内生产总值的 3 倍）。所有分析均由 TreeAge 2019 和 Microsoft Excel 进行。
对于稳定型心血管疾病、冠心病和外周动脉疾病患者，利伐沙班加阿司匹林与单独使用阿司匹林相比的增量成本效益比分别为 83459 美元、69852 美元和-13823 美元/质量调整生命年。概率敏感性分析显示，对于心血管疾病和冠心病患者，利伐沙班方案的成本效益概率分别为 44.1%和 65.3%，在 76368 美元的阈值下。
低剂量利伐沙班加阿司匹林不太可能成为稳定型心血管疾病患者二级预防的一种更具成本效益的替代方案；然而，从台湾国家支付者的角度来看，对于这些患者，该方案可能对仅患有慢性冠心病的患者具有药物经济学优势。药物经济学优势受药物价格、事件治疗费用和意愿支付阈值的影响。
