Goudarzi Zahra, Ghafari Darab Mohsen, Vazin Afsaneh, Hayatbakhsh Amirreza, Karimzadeh Iman, Jafari Mojtaba, Keshavarz Khosro, Borhani-Haghighi Afshin
Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Deakin University, Geelong, VIC, Australia; Institute for Medical Management and Health Sciences, University of Bayreuth, Bayreuth, Germany.
Value Health Reg Issues. 2023 Jan;33:99-108. doi: 10.1016/j.vhri.2022.09.006. Epub 2022 Nov 17.
Several studies have evaluated the economic evaluation of a group of medications known as novel oral anticoagulant drugs (NOACs) in recent years. The aim of this study is to review and systematically analyze the cost-utility studies results of warfarin compared with other NOAC drugs in atrial fibrillation patients.
A systematic review was performed to identify all studies evaluating the NOAC medications in comparison with warfarin. For this purpose, PubMed, Cochrane Library, ISI Web of Science, and Scopus were searched from 2013 to 2022. Articles were independently screened with inclusion criteria, and full texts were reviewed. First, the Consolidated Health Economic Evaluation Reporting Standards checklist was used to evaluate the quality of the articles. Then, the costs and outcomes of the studies were analyzed, and findings were appraised critically.
A total of 84 costs-per-quality-adjusted life-year (QALY) cases were extracted from the studies in which the share of rivaroxaban, edoxaban, apixaban, and dabigatran were 31%, 13%, 29%, and 27%, respectively. The median cost per QALY of rivaroxaban, edoxaban, apixaban, and dabigatran was 21 910$/QALY, 22 096$/QALY, 17 765$/QALY, and 24 161$/QALY, respectively. Subgroup analysis based on perspective showed that dabigatran had the highest incremental cost-effectiveness ratio (ICER) and edoxaban had the lowest ICER value. Edoxaban and apixaban had the highest and the lowest cost per QALY from an insurance perspective, respectively.
Despite the differences and variations in the economic evaluation studies of NOAC drugs, these drugs have shown acceptable cost-effectiveness in developed and developing countries. Among NOAC drugs, apixaban has the lowest ICER and the highest cost-effectiveness.
近年来，多项研究对一类名为新型口服抗凝药物（NOACs）进行了经济学评估。本研究旨在回顾并系统分析华法林与其他NOAC药物相比在房颤患者中的成本效用研究结果。
进行了一项系统综述，以确定所有评估NOAC药物与华法林对比的研究。为此，检索了2013年至2022年期间的PubMed、Cochrane图书馆、ISI科学网和Scopus。文章根据纳入标准进行独立筛选，并对全文进行评审。首先，使用《卫生经济评估报告标准合并清单》评估文章质量。然后，分析研究的成本和结果，并对研究结果进行严格评估。
从研究中总共提取了84个每质量调整生命年（QALY）成本案例，其中利伐沙班、依度沙班、阿哌沙班和达比加群的占比分别为31%、13%、29%和27%。利伐沙班、依度沙班、阿哌沙班和达比加群每QALY的中位成本分别为21910美元/QALY、22096美元/QALY、17765美元/QALY和24161美元/QALY。基于视角的亚组分析表明，达比加群的增量成本效益比（ICER）最高，依度沙班的ICER值最低。从保险角度来看，依度沙班和阿哌沙班分别具有最高和最低的每QALY成本。
尽管NOAC药物的经济学评估研究存在差异和变化，但这些药物在发达国家和发展中国家均显示出可接受的成本效益。在NOAC药物中，阿哌沙班的ICER最低，成本效益最高。
