对常规口服抗凝药的成本效益分析,用于为心房动和心房动进行心脏转换的低风险患者
Shawn Chhabra1,2, Krishan Yadav3,4,5, Miguel Cortel-LeBlanc6,7
1Department of Emergency Medicine, University of Ottawa, 1053 Carling Avenue, Room EM 206 Box 227, Ottawa, ON, K1Y4E9, Canada. schhabra@toh.ca.
CJEM
|October 23, 2025
概括
常规口服抗凝药 (OAC) 在心脏转变后用于急性心房/ (AF/AFL) 并非具有成本效益. 放弃OAC为没有中风风险因素的患者提供了稍微更好的生活质量和更低的成本.
科学领域:
- 卫生经济学 卫生经济学
- 心脏病学 心脏病学
- 公共卫生政策 公共卫生政策
背景情况:
- 加拿大指导方针推四周口服抗凝药 (OAC) 用于治疗急性心房/ (AF/AFL) 的心脏转变,不论中风风险如何.
- 心脏转变后的中风虽然很少发生,但会带来大量的发病率和医疗费用.
- 评估常规OAC心转术后的成本效益对于优化患者护理和资源配置至关重要.
研究的目的:
- 评估为急性心房动/动 (AF/AFL) 进行心脏转变后提供常规四周口服抗凝药 (OAC) 与没有OAC的成本效益.
- 从加拿大公共支付人的角度来比较临床结果,生活质量和成本.
- 为临床实践指南提供有关心脏转变后抗凝策略的信息.
主要方法:
- 使用决策树模型进行了成本效益分析.
- 这项研究比较了没有OAC与四周的OAC在成年人急性AF/AFL和没有风险因素 (CCS算法CHADS-65).
- 使用10,000个蒙特卡洛模拟进行的概率灵敏度分析评估了研究结果的稳定性.
主要成果:
- 没有OAC的策略占主导地位,以更低的成本 (加拿大108.86美元对加拿大117.73美元) 获得略高的质量调整寿命日 (296日对295日).
- 增量净货币收益有利于没有OAC的策略,为25.22美元.
- 概率灵敏度分析表明,无OAC选项在69.5%的代中具有成本效益,这是由于心脏转变后事件率较低所致.
结论:
- 在低风险患者急性AF/AFL心脏转变后放弃常规口服抗凝药,结果在结果中差异很小.
- 与常规的OAC相比,无OAC策略显示了生活质量的轻微改善和成本的降低.
- 这些发现表明,加拿大当前关于心转动后心房管理指南的潜在修订.
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