アピキサバンとアスピリンの費用対効果 ARTESiA試験の洞察
Andre Lamy1, Roopinder K Sandhu2,3, Wesley Tong1
1Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
まとめ
アピキサバンは,サブクリニック性心房細動 (SCAF) と脳卒中リスクが高い患者の脳卒中予防に費用を節約します. ドイツでは費用対効果が高く アメリカでは薬の価格を下げてコストを削減できます
科学分野:
- 心臓病科
- 健康 経済
- 薬学経済学
背景:
- サブクリニック性心房細動 (SCAF) は脳卒中と全身栓塞のリスクを伴う.
- アピキサバンはARTESiA試験において,特にCHA2DS2- VAScスコアが4以上の患者に対して,アスピリンよりも優れていることを示した.
- SCAFに対するアピキサバン治療の経済的影響を理解することは,医療の意思決定において極めて重要です.
研究 の 目的:
- SCAFとCHA2DS2- VAScスコア4以上の患者の脳卒中予防におけるアピキサバンとアスピリンの費用対効果を評価する.
- カナダ,イギリス,ドイツ,アメリカにおける 直接的な医療費と薬費の分析です
主な方法:
- 直接的な医療費 (2023ドル) は,入院事件と試験薬の費用を試験参加者に適用した (平均フォローアップ期間は3. 5年).
- マルコフモデルは,品質調整生命年 (QALY) につき5万ドルの支払意向の値を含む,終身費用効果分析に使用された.
- アピキサバンの日々の費用は国によって異なる: カナダ $0. 63,英国 $0. 11,ドイツ $2. 26,米国 $6. 06
主要な成果:
- アピキサバンは,試験期間中にカナダ (- 2,301ドル) とイギリス (- 902ドル) でコスト削減を図った.
- ドイツと米国では,試験中にアピキサバンがより高い費用 (それぞれ600ドルと1,990ドル) を負担しました.
- ライフタイム分析では,アピキサバンは0. 107 QALYの純利益をもたらしたが,ドイツでは24, 514 QALY,米国では85, 140 QALYのインクリメンタルコスト・エフェクティビティ比率 (ICER) を示した.
結論:
- アピキサバンは,CHA2DS2- VAScスコア> 4のSCAF患者に対して,カナダと英国でコストを削減します.
- ドイツではアピキサバンによる治療は費用対効果が高い.
- アピキサバンは ベース仮定では 費用対効果が高くなかったが 日々の費用が減れば 費用対効果が高くなる可能性がある.
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