不同医疗保险形式下房颤患者应用口服抗凝药预防卒中的成本-效果分析  

Oral anticoagulants for stroke prevention in atrial fibrillation:a cost-effectiveness analysis under different medical insurances in China

作　　者：崔璨[1] 刘怡[1] 崔向丽 卫红涛[1] CUI Can;LIU Yi;CUI Xiang-li;WEI Hong-tao(Department of Pharmacy,Beijing Friend ship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院药剂科,北京100050

出　　处：《临床药物治疗杂志》2020年第12期63-68,共6页Clinical Medication Journal

摘　　要：目的纳入中国房颤人群的患者数据,评价新型口服抗凝药达比加群、利伐沙班与华法林在城镇医保、新型农村合作医疗、完全自费3种不同医疗保险形式下用于预防卒中的成本-效果。方法根据非瓣膜性房颤疾病自然史构建Markov模型,从3种不同医疗保险形式的支付者角度比较华法林36 mg、利伐沙班20 mg、达比加群110与150 mg的整体医疗成本,预测不同治疗方案下获得的质量调整生命年(QALY),并计算增量成本-效果比(ICER)。结果非瓣膜性房颤患者接受华法林、利伐沙班、达比加群110 mg bid和150 mg bid可获得的QALY分别为11.07、15.46、12.40和15.00年。城镇医保患者,当支付意愿(WTP)为1倍城镇居民可支配收入36 396.00元时,利伐沙班为优势方案;新农合患者,当WTP为1倍农村居民人均可支配收入13 432.00元时,华法林为优势方案;完全自费患者,当WTP<60 688.5元时,华法林为优势方案。WTP>60 688.5元时,利伐沙班为优势方案。结论在非瓣膜性房颤患者中,医疗保险待遇及支付意愿能够影响患者治疗方案决策。Objective To evaluate the cost-effectiveness of new anticoagulants(dabigatran and rivaroxaban)and warfarin in the prevention of stroke in Chinese patients with atrial fibrillation,in the perspectives of 3 different medical insurance including urban medical insurance,new rural cooperative medical system(NCMS),and self-payment.Methods A Markov state transition model was built based on the natural history of nonvalvular atrial fibrillation.The expected health care costs of warfarin 3-6 mg,rivaroxaban 20 mg,dabigatran 110 and 150 mg was estimated respectively in terms of 3 different medical insurance.The quality adjusted life years(QALYs)obtained under different treatment schemes were predicted,and the incremental cost-effectiveness ratio(ICER)was calculated.Results for patients with non-valvular atrial fibrillation who received warfarin,rivaroxaban,dabigatran,the QALYs available was 11.07,15.46,12.40 and 15.00 years,respectively.For urban medical insurance patients,when the willingness to pay(WTP)was equal to disposable income of urban residents of 36396.00 yuan,rivaroxaban was the advantage choice;For new rural cooperative medical patients,when WTP was equal to disposable income of rural residents of 13 432.00 yuan,warfarin was an advantage choice.Those who did not participated in medical insurance,when the WTP is greater than 60 688.5 yuan,rivaroxaban was the superior solution,and If not,warfarin was the advantage.Conclusion Among Chinese nonvalvular atrial fibrillation population,basic medical insurance benefits and patients’ willingness to pay can affect the decision-making of treatment options.

关 键 词：成本-效果 华法林 新型口服抗凝药 医保待遇 中国人群 

分 类 号：R956[医药卫生—药学] R973.2