PDF(Pubmed)
Abstract：
BACKGROUND: This study evaluates the cost-effectiveness of Apixaban and Rivaroxaban, compared to Warfarin, for stroke prevention in patients with non-valvular atrial fibrillation in Iran.
METHODS: A Markov model with a 30-year time horizon was employed to simulate and assess different treatment strategies\' cost-effectiveness. The study population comprised Iranian adults with NVAF, identified through specialist consultations, hospital visits, and archival record reviews. Direct medical costs, direct nonmedical, and indirect costs were included. Quality-adjusted life years (QALY) were assessed using an EQ-5D questionnaire. This study utilized a cost-effectiveness threshold of $11 134 per QALY.
RESULTS: Apixaban demonstrated superior cost-effectiveness compared to Rivaroxaban and Warfarin. Over 30 years, total costs were lower in the Apixaban and Rivaroxaban groups compared to the Warfarin group ($126.18 and $109.99 vs. $150.49). However, Apixaban showed higher total QALYs gained compared to others (0.134 vs. 0.133 and 0.116). The incremental cost-effectiveness ratio for comparing Apixaban to Warfarin was calculated at -1332.83 cost per QALY, below the threshold of $11 134, indicating Apixaban\'s cost-effectiveness. Sensitivity analyses confirmed the robustness of the findings, with ICER consistently remaining below the threshold. Over 5 years (2024-2028) of Apixaban usage, the incremental cost starts at USD 70 250 296 in the first year and gradually rises to USD 71 770 662 in the fifth year. DSA and PSA were assessed to prove the robustness of the results.
CONCLUSIONS: This study shows that Apixaban is a cost-effective option for stroke prevention in non-valvular atrial fibrillation patients in Iran compared to Warfarin.
METHODS: A Markov model with a 30-year time horizon was employed to simulate and assess different treatment strategies\' cost-effectiveness. The study population comprised Iranian adults with NVAF, identified through specialist consultations, hospital visits, and archival record reviews. Direct medical costs, direct nonmedical, and indirect costs were included. Quality-adjusted life years (QALY) were assessed using an EQ-5D questionnaire. This study utilized a cost-effectiveness threshold of $11 134 per QALY.
RESULTS: Apixaban demonstrated superior cost-effectiveness compared to Rivaroxaban and Warfarin. Over 30 years, total costs were lower in the Apixaban and Rivaroxaban groups compared to the Warfarin group ($126.18 and $109.99 vs. $150.49). However, Apixaban showed higher total QALYs gained compared to others (0.134 vs. 0.133 and 0.116). The incremental cost-effectiveness ratio for comparing Apixaban to Warfarin was calculated at -1332.83 cost per QALY, below the threshold of $11 134, indicating Apixaban\'s cost-effectiveness. Sensitivity analyses confirmed the robustness of the findings, with ICER consistently remaining below the threshold. Over 5 years (2024-2028) of Apixaban usage, the incremental cost starts at USD 70 250 296 in the first year and gradually rises to USD 71 770 662 in the fifth year. DSA and PSA were assessed to prove the robustness of the results.
CONCLUSIONS: This study shows that Apixaban is a cost-effective option for stroke prevention in non-valvular atrial fibrillation patients in Iran compared to Warfarin.
摘要：
背景：这项研究评估了阿哌沙班和利伐沙班的成本效益，与华法林相比,伊朗非瓣膜性心房颤动患者的卒中预防。
方法：采用30年时间范围的马尔可夫模型来模拟和评估不同的治疗策略的成本效益。研究人群包括患有NVAF的伊朗成年人，通过专家咨询确定，医院就诊,和档案记录审查。直接医疗费用,直接非医疗，并包括间接成本。使用EQ-5D问卷评估质量调整生命年(QALY)。这项研究使用了每QALY11134美元的成本效益阈值。
结果：与利伐沙班和华法林相比，阿哌沙班表现出更高的成本效益。30多年来,与华法林组相比，阿哌沙班和利伐沙班组的总成本较低($126.18和$109.99vs.150.49美元）。然而,阿哌沙班显示，与其他相比，获得的总QALY更高（0.134vs.0.133和0.116）。将阿哌沙班与华法林进行比较的增量成本效益比计算为-1332.83每QALY成本，低于11134美元的门槛，表明阿哌沙班的成本效益。敏感性分析证实了研究结果的稳健性，ICER始终低于阈值。超过5年（2024-2028）的阿哌沙班使用，第一年的增量成本从70250296美元开始，第五年逐渐上升到71770662美元。评估DSA和PSA以证明结果的稳健性。
结论：这项研究表明，与华法林相比，在伊朗非瓣膜性房颤患者中，阿哌沙班是一种具有成本效益的预防中风的选择。
方法：采用30年时间范围的马尔可夫模型来模拟和评估不同的治疗策略的成本效益。研究人群包括患有NVAF的伊朗成年人，通过专家咨询确定，医院就诊,和档案记录审查。直接医疗费用,直接非医疗，并包括间接成本。使用EQ-5D问卷评估质量调整生命年(QALY)。这项研究使用了每QALY11134美元的成本效益阈值。
结果：与利伐沙班和华法林相比，阿哌沙班表现出更高的成本效益。30多年来,与华法林组相比，阿哌沙班和利伐沙班组的总成本较低($126.18和$109.99vs.150.49美元）。然而,阿哌沙班显示，与其他相比，获得的总QALY更高（0.134vs.0.133和0.116）。将阿哌沙班与华法林进行比较的增量成本效益比计算为-1332.83每QALY成本，低于11134美元的门槛，表明阿哌沙班的成本效益。敏感性分析证实了研究结果的稳健性，ICER始终低于阈值。超过5年（2024-2028）的阿哌沙班使用，第一年的增量成本从70250296美元开始，第五年逐渐上升到71770662美元。评估DSA和PSA以证明结果的稳健性。
结论：这项研究表明，与华法林相比，在伊朗非瓣膜性房颤患者中，阿哌沙班是一种具有成本效益的预防中风的选择。
