Xing Yuanming, Qiu Yulan, Yang Luting, Yuan Zuyi, Wang Yan
Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Int J Cardiol. 2023 Jan 15;371:420-426. doi: 10.1016/j.ijcard.2022.10.015. Epub 2022 Oct 10.
The innovative pharmacological combination of low-dose rivaroxaban plus aspirin provides clinicians with an ideal opportunity to intensify the medical treatment of patients with coronary artery disease (CAD) and comorbid peripheral artery disease (PAD). We aimed to determine the cost-effectiveness of PAD screening using the ankle-brachial index (ABI) test in patients with CAD (with rivaroxaban administered if the PAD screening was positive) compared with no-screening strategy in China.
A Markov decision model using a 1-month cycle was developed to simulate the 25-year effectiveness and cost of PAD screening on 75-year-old patients with CAD in China, evaluating the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were conducted to assess the impact of variations in the key parameters for ICERs.
Our model found an incremental cost of RMB4,959 (US$740) and an incremental QALY of 0.054 after one-time ABI screening, leading to an ICER of RMB91,936 (US$13,717) per QALY gained over a 25-year period. The reduction in all-cause mortality related to rivaroxaban and its cost were the factors most affecting the ICER. The screening would become cost-effective by decreasing the monthly cost of rivaroxaban to RMB184.5 (US$27.5) or by using domestic-brand rivaroxaban according to the threshold of a willingness to pay RMB72,447 (US$10,809) per QALY gained.
Our study demonstrated that ABI screening for PAD to decide on low-dose rivaroxaban administration was not cost-effective for patients with CAD in China. Nevertheless, policy-guided cost changes for domestic-brand rivaroxaban could easily resolve this issue.
低剂量利伐沙班联合阿司匹林这种创新性药物组合，为临床医生强化治疗冠状动脉疾病（CAD）合并外周动脉疾病（PAD）的患者提供了理想契机。我们旨在确定在中国，对CAD患者采用踝臂指数（ABI）检测进行PAD筛查（若PAD筛查呈阳性则给予利伐沙班治疗）相较于不进行筛查策略的成本效益。
构建了一个以1个月为周期的马尔可夫决策模型，以模拟在中国对75岁CAD患者进行PAD筛查的25年有效性和成本，评估质量调整生命年（QALY）和增量成本效益比（ICER）。进行了单向、双向和概率敏感性分析，以评估ICER关键参数变化的影响。
我们的模型发现，一次性ABI筛查后增量成本为4959元人民币（740美元），增量QALY为0.054，在25年期间每获得1个QALY的ICER为91936元人民币（13717美元）。与利伐沙班相关的全因死亡率降低及其成本是对ICER影响最大的因素。通过将利伐沙班的月成本降至184.5元人民币（27.5美元）或根据每获得1个QALY支付意愿阈值72447元人民币（10809美元）使用国产利伐沙班，筛查将变得具有成本效益。
我们的研究表明，在中国，对CAD患者进行ABI筛查以决定是否给予低剂量利伐沙班治疗不具有成本效益。然而，国产利伐沙班在政策引导下的成本变化可轻松解决这一问题。
