Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
Expert Rev Pharmacoecon Outcomes Res. 2022 Jan;22(1):93-100. doi: 10.1080/14737167.2021.1883429. Epub 2021 Feb 10.
Atrial fibrillation (AF) can lead to a significant health and economic burden to society. This study aimed to assess the net budget impact of direct-acting oral anticoagulants (DOACs) instead of warfarin for stroke prevention in patients with non-valvular AF from the payer's perspective.
A budget model over a 5-year period was used. Dabigatran 150 mg, dabigatran 110 mg, apixaban 5 mg, rivaroxaban 20 mg, edoxaban 60 mg, and edoxaban 30 mg were included. Inputs were retrieved from published literature. Adoption rate of DOACs started at 5% and subsequently had a 5% increase in each year. Net budget impact (NBI) and sensitivity analyses were performed.
The average NBI over the 5-year horizon for all DOACs ranged from 12.3 M USD to 13.9 M USD. Dabigatran 150 mg had the highest NBI, while edoxaban 30 mg had the lowest NBI. The average NBI/patient/year ranged from 63.03 USD - 70.75 USD.
Of all DOACs, edoxaban 30 mg, apixaban 5 mg, and edoxaban 60 mg are the top 3 lowest NBI. Together with cost-effectiveness evidence, those DOACs should be considered to be listed on the National List of Essential Medicine in Thailand.
心房颤动（AF）会给社会带来重大的健康和经济负担。本研究旨在从支付者的角度评估直接口服抗凝剂（DOACs）替代华法林用于非瓣膜性心房颤动患者卒中预防的净预算影响。
使用了为期 5 年的预算模型。达比加群 150mg、达比加群 110mg、阿哌沙班 5mg、利伐沙班 20mg、依度沙班 60mg 和依度沙班 30mg 被包括在内。投入数据来自已发表的文献。DOACs 的采用率从 5%开始，随后每年增加 5%。进行了净预算影响（NBI）和敏感性分析。
在 5 年的时间内，所有 DOACs 的平均 NBI 范围在 1230 万至 1390 万美元之间。达比加群 150mg 的 NBI 最高，而依度沙班 30mg 的 NBI 最低。每个患者每年的平均 NBI 范围在 63.03 至 70.75 美元之间。
在所有 DOACs 中，依度沙班 30mg、阿哌沙班 5mg 和依度沙班 60mg 的 NBI 最低。结合成本效益证据，这些 DOACs 应被考虑列入泰国国家基本药物目录。
