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| 標題: | Cost-Effectiveness Analysis of Oral Anticoagulants in Stroke Prevention among Patients with Atrial Fibrillation in Taiwan |
| 作者: | Liao, Chia-Te
Lee, Mei-Chuan
Chen, Zhih-Cherng
Ku, Li-Jung Elizabeth
Wang, Jung-Der
Toh, Han Siong |
| 貢獻者: | Chi Mei Med Ctr, Dept Cardiol
Natl Cheng Kung Univ, Coll Med, Dept Publ Hlth
Chi Mei Med Ctr, Dept Pharm
Chia Nan Univ Pharm & Sci, Dept Pharm
Chi Mei Med Ctr, Dept Intens Care Med
Natl Cheng Kung Univ, Inst Clin Med |
| 關鍵字: | Anticoagulant therapy
Atrial fibrillation
Cost-effectiveness analysis |
| 日期: | 2020 |
| 上傳時間: | 2022-11-18 11:24:43 (UTC+8) |
| 出版者: | Taiwan Soc Cardiology |
| 摘要: | Background: Non-vitamin K oral antagonist anticoagulants (NOACs) have been widely used in stroke prevention in atrial fibrillation (SPAF). The aim of this study was to compare the pharmacoeconomic impact of oral anticoagulants (OACs) including warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban in SPAF in Taiwan. Methods: A decision tree, Markov model, and multiple sensitivity analyses were used to project the lifetime costs and quality-adjusted life years (QALYs) of OACs. Transitional probabilities were derived from a systematic review and network meta-analysis for Asian populations. Utilities and costs were obtained from published studies and the Taiwan National Health Insurance Research Database. Threshold of the willingness to pay (WTP) at USD 20,000 was applied to evaluate the results. Results: In base-case analysis, warfarin had the lowest cost at $13,363 4,036, and edoxaban 60 mg produced the most QALYs at 11.92 +/- 1.98. The incremental cost-effectiveness ratios of dabigatran 150 and 110 mg, rivaroxaban 20 and 15 mg, apixaban 5 mg, and edoxaban 60 mg versus warfarin were $6,415, $4,225, $4,115 and $5,458 per QALY gained, respectively. Monte Carlo analysis revealed that dabigatran 150 and 110 mg, rivaroxaban 20 and 15 mg, apixaban 5 mg and edoxaban 60 mg were most cost-effective at 21.9%, 27.1%, 23.6%, and 27.4% of $20,000 compared to warfarin. Conclusions: From a Taiwan national payer perspective, all NOACs are cost-effective substitutes for warfarin in SPAF. However, the likelihood of cost-effective iterations for NOACs is highly driven by their market prices at the time and different WTP thresholds of policymakers. |
| 關聯: | Acta Cardiologica Sinica, v.36, n.1, pp.12 |
| 顯示於類別: | [藥學系(所)] 期刊論文
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