里瓦罗克萨班与华法林治疗术后心房:单中心,随机和前性试验中的成本效益分析
Marcel de Paula Pereira1, Eduardo Gomes Lima1, Fabio Grunspun Pitta1
1Instituto do coração, Hospital das clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.
JTCVS open
|October 9, 2023
概括
里瓦罗克萨班是一种比华法林更具成本效益的抗凝剂,用于预防冠状动脉旁路移植手术后的中风和死亡. 这项研究发现,在术后心房的患者中,里瓦洛克萨班显著降低了成本,并提高了成本效益.
科学领域:
- 心脏病学 心脏病学
- 药物经济学 药物经济学
- 临床试验 临床试验
背景情况:
- 手术后心房动 (POAF) 是冠状动脉旁路移植 (CABG) 手术后的常见并发症.
- POAF增加了中风,死亡,住院和医疗费用的风险.
- 有效的抗凝血策略对于管理POAF及其并发症至关重要.
研究的目的:
- 为了比较利瓦罗克萨班与华法林加因奥沙巴林在CABG后POAF患者的成本效益.
- 评估这些抗凝血策略的临床结果和安全性.
主要方法:
- 一个单中心,随机化,前性,开放标签研究,涉及53名CABG后POAF患者.
- 患者被随机分配,接受里瓦罗克萨班或华法林与埃诺沙巴林桥接.
- 通过SF-6D问卷,使用质量调整的寿命年 (QALYs) 评估了成本效益. 二次结局包括死亡,中风,心肌梗塞,血栓栓塞事件,出血和再入院.
主要成果:
- 与华法林 (1423.20美元) (P = .002) 相比,里瓦罗克萨班的成本效益显著提高 (586.80美元).
- 里瓦洛克萨班组的中位成本 (450.20美元) 与华法林组 (947.30美元) (P <.001) 相比,里瓦洛克萨班组的中位成本要低得多.
- 临床结果 (44.4%与38.5%,P = .65) 和出血率 (25.9%与11.5%,P = .18) 在两组之间相似.
结论:
- 里瓦罗克萨班是一种更具成本效益的抗凝药选择,用于管理POAF在隔离CABG后的治疗,而不是与埃诺沙巴林桥接的华法林.
- 这项研究支持使用里瓦洛克萨班来改善经济结果,而不会影响临床疗效或安全.
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