BACKGROUND AND OBJECTIVE:To evaluate the cost-effectiveness of new anticoagulants and warfarin in the prevention of stroke in Chinese patients with atrial fibrillation (AF). METHODS:The Markov model was constructed to compare patients' quality-adjusted life-years (QALYs) using drug cost, the cost of the examination after taking a drug, and the incremental cost of other treatments. Both dabigatran (110 and 150 mg, twice a day) and rivaroxaban (20 mg, once a day) were compared with warfarin (3-6 mg, once a day). Willingness to pay, three times the 2018 China GDP per capita (9481.88 $), was the cost-effect threshold in our study. RESULTS:The total cost were was 5317.31$, 29673.33$, 23615.49$, and 34324.91$ for warfarin, rivaroxaban, dabigatran 110 mg bid, and dabigatran 150 mg bid, respectively. The QALYs for each of the four interventions were 11.07 years, 15.46 years, 12.4 years, and 15 years, respectively. The cost-effectiveness analysis of the three new oral anticoagulants and warfarin showed that the incremental cost-effectiveness ratio (ICER) was 5548.07$/QALY when rivaroxaban was compared with warfarin. Rivaroxaban was the most cost-effective choice and warfarin was the least. CONCLUSIONS:In Chinese patients with AF, although warfarin is cheaper, rivaroxaban has a better cost-effectiveness advantage from an economic point of view.

译文

背景与目的:评价新型抗凝药和华法林在中国房颤患者中的预防成本效益。
方法:建立马尔可夫模型以比较使用药物成本,服药后检查的成本以及其他治疗的增量成本的患者的质量调整生命年(QALYs)。将达比加群(110和150 mg,每天两次)和利伐沙班(20 mg,每天一次)与华法林(3-6 mg,每天一次)进行比较。在我们的研究中,支付意愿是2018年中国人均GDP(9481.88 $)的三倍。
结果:华法林,利伐沙班,达比加群110 mg出价和达比加群150 mg出价的总成本分别为5317.31 $,29673.33 $,23615.49 $和34324.91 $。四种干预措施的QALYs分别为11.07年,15.46年,12.4年和15年。三种新型口服抗凝药和华法林的成本效益分析表明,将利伐沙班与华法林比较时,增量成本效益比(ICER)为5548.07 $ / QALY。利伐沙班是最具成本效益的选择,而华法林则是最少的选择。
结论:在中国房颤患者中,尽管华法林价格便宜,但从经济角度考虑,利伐沙班具有更好的成本效益优势。

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