达比加特兰用于心房动中风预防的成本效益
1Department of Medicine, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave, St. Louis, MO 63110, USA. bgage@im.wustl.edu
Circulation
|May 25, 2011
概括
对于心房的患者,达比加特兰150毫克对于高风险患者是具有成本效益的,而华法林对中等风险患者是最好的,这取决于出血风险和国际正常化比率控制.
科学领域:
- 药物经济学 药物经济学
- 心脏病学 心脏病学
- 卫生经济学 卫生经济学
背景情况:
- 华法林一直是心房动 (AF) 中中风预防的标准.
- 新兴抗凝剂需要对临床采用进行成本效益评估.
- 患者特异性风险因素影响最佳抗血栓治疗选择.
研究的目的:
- 为了比较各种抗血栓治疗的成本效益,用于AF患者中风预防.
- 根据患者中风和出血风险,确定最具成本效益的抗凝药策略.
- 评估国际规范化比率 (INR) 控制对华法林成本效益的影响.
主要方法:
- 使用RE-LY试验和其他来源的数据开发了一个决策分析马尔科夫模型.
- 该模型模拟了70岁的AF患者的假设队列.
- 对成本效益的评估是根据每年质量调整后寿命年限为5万美元的门进行评估.
主要成果:
- 达比加特兰150毫克每天两次对高风险中风的AF患者具有成本效益,除非华法林的INR控制是优秀的 (>72.6%的时间在治疗范围内).
- 华法林在中度中风风险的AF患者中具有成本效益,除非INR控制较差 (治疗范围内的时间<57.1%).
- 阿司匹林单一治疗仅在最低的中风风险组 (CHADS2分数为0) 具有成本效益. 达比加特兰110毫克和双重抗血小板治疗没有成本效益.
结论:
- 达比加特兰150毫克为高风险的AF患者提供了具有成本效益的替代方案,特别是当华法林的INR控制低于最佳时.
- 华法林仍然是适度风险的AF患者具有良好的INR管理的成本有效选择.
- 治疗选择应根据中风风险,出血风险和INR控制质量进行个性化选择.
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