基于药物基因组学（PGx）的华法林、阿哌沙班和利伐沙班与标准华法林治疗加拿大安大略省心房颤动的成本效益分析。
Cost-Effectiveness Analysis of Pharmacogenomics (PGx)-Based Warfarin, Apixaban, and Rivaroxaban Versus Standard Warfarin for the Management of Atrial Fibrillation in Ontario, Canada.
机构信息
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
Ivey Business School, Western University, London, ON, Canada.
出版信息
Pharmacoeconomics. 2024 Jan;42(1):69-90. doi: 10.1007/s40273-023-01309-z. Epub 2023 Aug 19.
OBJECTIVE
To assess the cost-effectiveness of pharmacogenomics (PGx)-based warfarin (i.e., warfarin dosing following genetic testing), apixaban, and rivaroxaban oral anticoagulation versus standard warfarin for the treatment of newly diagnosed patients with nonvalvular atrial fibrillation (AF) aged ≥ 65 years.
METHODS
We developed a Markov decision-analytic model to compare costs [2017 Canadian dollars (C$)] and quality-adjusted life years (QALYs) from the Ontario health care payer perspective over a life-time horizon. The parameters used in the model were derived from the published literature, the Ontario health care administrative database, and expert opinion. To account for the uncertainty of model parameters, we conducted extensive deterministic and probabilistic sensitivity analyses. The results were summarized using incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves.
RESULTS
We found that PGx-based warfarin had an ICER of C$17,584/QALY compared with standard warfarin, and apixaban had an ICER of C$64,590/QALY compared with PGx-based warfarin in our base-case analysis. Rivaroxaban was extendedly dominated by PGx-based warfarin and apixaban. The probabilistic sensitivity analysis showed that apixaban, rivaroxaban, PGx-based warfarin, and standard warfarin were cost-effective at some willingness-to-pay (WTP) thresholds. PGx-based warfarin had a higher probability of being cost-effective than apixaban (51.3% versus 14.3%) at a WTP threshold of C$50,000/QALY. At a WTP threshold of C$100,000/QALY, apixaban had a higher probability of being cost-effective than PGx-based warfarin (54.6% versus 22.6%).
CONCLUSION
We found that PGx-based warfarin for patients with AF is cost-effective at a WTP threshold of C$50,000/QALY. Apixaban had a higher probability of being cost-effective (> 50%) at a WTP threshold of C$93,000/QALY.
目的
评估基于药物基因组学（PGx）的华法林（即基因检测后华法林剂量）、阿哌沙班和利伐沙班口服抗凝剂与标准华法林治疗新诊断的年龄≥65 岁的非瓣膜性心房颤动（AF）患者的成本效益。
方法
我们开发了一个马尔可夫决策分析模型，从安大略省医疗保健支付者的角度比较了终生的成本[2017 年加拿大元（C$）]和质量调整生命年（QALY）。模型中使用的参数来自已发表的文献、安大略省医疗保健管理数据库和专家意见。为了考虑模型参数的不确定性，我们进行了广泛的确定性和概率敏感性分析。结果使用增量成本效益比（ICER）和成本效益接受曲线进行总结。
结果
在我们的基础案例分析中，我们发现基于 PGx 的华法林与标准华法林相比，ICER 为 C$17,584/QALY，阿哌沙班与基于 PGx 的华法林相比，ICER 为 C$64,590/QALY。利伐沙班在基于 PGx 的华法林和阿哌沙班方面被广泛超越。概率敏感性分析表明，阿哌沙班、利伐沙班、基于 PGx 的华法林和标准华法林在某些意愿支付（WTP）阈值下具有成本效益。在 WTP 阈值为 C$50,000/QALY 时，基于 PGx 的华法林比阿哌沙班更有可能具有成本效益（51.3%比 14.3%）。在 WTP 阈值为 C$100,000/QALY 时，阿哌沙班比基于 PGx 的华法林更有可能具有成本效益（54.6%比 22.6%）。
结论
我们发现，在 WTP 阈值为 C$50,000/QALY 时，基于 PGx 的华法林治疗 AF 患者具有成本效益。在 WTP 阈值为 C$93,000/QALY 时，阿哌沙班具有更高的成本效益概率（>50%）。
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