Arabloo Jalal, Rezaei Mohammad Ali, Makhtoumi Vahid, Sadiani Zahra Mollaei, Rezapour Aziz
Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
Eur J Clin Pharmacol. 2025 Feb;81(2):279-290. doi: 10.1007/s00228-024-03794-3. Epub 2024 Dec 23.
This study aimed to systematically review the cost-effectiveness of rivaroxaban plus aspirin (RIV + ASA) versus aspirin (ASA) alone in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD).
A systematic review was conducted using leading databases including PubMed, Scopus, and Web of Science core collection. The search was carried out up to June 25, 2024, focusing on identifying full economic evaluation studies comparing the cost-effectiveness of RIV + ASA versus ASA alone in patients with stable cardiovascular diseases (CVDs). The methodological quality of the included studies was assessed utilizing the validated Quality of Health Economics Studies (QHES) checklist. Subsequently, a qualitative analysis was performed to synthesize the collected data. We converted the incremental cost-effectiveness ratios (ICERs) into the equivalent amount in US dollars for the year 2024.
Out of 315 identified articles, 11 met inclusion criteria and were included in the review. RIV + ASA was generally found to be cost-effective, with ICERs falling within acceptable willingness-to-pay (WTP) thresholds. However, substantial variation in ICERs was observed across studies due to differences in healthcare systems, drug pricing, and WTP thresholds. In these studies, ICERs per quality-adjusted life-year (QALY) were (in 2024 US dollars) US$4939 to $29,162 for all patients, $10,385 to $85,394 for CAD, and $1013 to $40,244 for PAD in different studies. RIV + ASA was more cost-effective in high-risk subgroups, such as patients with PAD. Key drivers of cost-effectiveness included mortality rates, the cost of rivaroxaban, and utility scores.
RIV + ASA appears to be a cost-effective treatment option for patients with CAD or PAD or both. Future research should address geographical biases, consider societal perspectives, and explore alternative treatment options to optimize resource allocation and improve patient outcomes in the management of CVDs. Future research should also consider evaluating the cost-effectiveness of alternative new oral anticoagulants (NOACs) to provide a broader perspective on treatment options for CVD.
本研究旨在系统评价利伐沙班联合阿司匹林（RIV+ASA）与单用阿司匹林（ASA）相比，在稳定型冠状动脉疾病（CAD）或外周动脉疾病（PAD）患者中的成本效益。
使用包括PubMed、Scopus和Web of Science核心合集在内的主要数据库进行系统评价。检索截至2024年6月25日的文献，重点是识别比较RIV+ASA与单用ASA在稳定型心血管疾病（CVD）患者中成本效益的完整经济评价研究。采用经过验证的卫生经济学研究质量（QHES）清单评估纳入研究的方法学质量。随后，进行定性分析以综合收集到的数据。我们将增量成本效益比（ICER）换算为2024年的等效美元金额。
在315篇识别出的文章中，11篇符合纳入标准并被纳入本评价。RIV+ASA总体上被认为具有成本效益，ICER落在可接受的支付意愿（WTP）阈值范围内。然而，由于医疗保健系统、药品定价和WTP阈值的差异，各研究间ICER存在很大差异。在这些研究中，不同研究中每质量调整生命年（QALY）的ICER（以2024年美元计），所有患者为4939美元至29162美元，CAD患者为10385美元至85394美元，PAD患者为1013美元至40244美元。RIV+ASA在高风险亚组（如PAD患者）中更具成本效益。成本效益的关键驱动因素包括死亡率、利伐沙班成本和效用评分。
RIV+ASA似乎是CAD或PAD或两者兼具患者的一种具有成本效益的治疗选择。未来的研究应解决地域偏差问题，考虑社会视角，并探索替代治疗方案，以优化资源分配并改善CVD管理中的患者结局。未来的研究还应考虑评估替代新型口服抗凝剂（NOAC）的成本效益，以便为CVD治疗方案提供更广泛的视角。
