基于马尔科夫模型非瓣膜性心房颤动治疗策略的药物经济学评价  

Pharmacoeconomic Valuation of Strategies for Treatment of Nonvalvular Atrial Fibrillation Based on Markov Model

作　　者：王栓 黄灿[1] 齐腊梅[1] WANG Shuan;HUANG Can;QI La-Mei(Department of Pharmaceutical Administration,Anqing Municipal Hospital,Anqing 246000,China)

机构地区：[1]安庆市立医院药事管理科,安徽安庆246000

出　　处：《中国药物经济学》2022年第8期39-44,共6页China Journal of Pharmaceutical Economics

基　　金：北京医卫健康公益基金(B20308EN)。

摘　　要：目的比较利伐沙班与华法林治疗非瓣膜性心房颤动的成本-效果。方法从Meta分析中获得两种方案治疗非瓣膜性心房颤动的栓塞概率、出血概率;成本来自某三甲医院收费标准及已发表的文献。从支付者角度,用基于文献的马尔科夫(Markov)模型进行成本-效果分析,采用概率敏感性分析及单因素敏感性分析对结果稳定性进行分析。结果Markov模型分析显示:与华法林相比,利伐沙班的增量成本为16288.000元,增量效果为0.65 QALYs,增量成本-效果比(ICER)为25058.462元/QALY<意愿支付(WTP)阈值。概率敏感性分析:WTP阈值=212676元,利伐沙班接受率100%;单因素敏感性分析:利伐沙班组成本对结局影响较为显著。结论利伐沙班治疗非瓣膜性心房颤动时,与华法林相比,更具经济学优势。Objective To compare the cost-effectiveness of rivaroxaban and warfarin in the treatment of nonvalvular atrial fibrillation.Methods The embolization probability and bleeding probability of the treatment of nonvalvular atrial fibrillation were obtained from Meta-analysis.The cost came from the charging standard of a third class hospital and the published literature.From the perspective of payers,the cost-effectiveness analysis was carried out by using the Markov model based on literature,and the sensitivity of the results was analyzed by using Probability sensitivity analysis and single factor sensitivity analysis.Results Markov model analysis showed that compared with warfarin,the incremental cost of rivaroxaban was 16288.000 yuan,the incremental effect was 0.65 QALYs,and the incremental cost-effectiveness ratio(ICER)was 25058.462 yuan/QALY<WTP.Probabilistic sensitivity analysis:WTP=212676 yuan,and the acceptance rate of rivaroxaban was 100%;Single factor sensitivity analysis showed that the cost of rivaroxaban had a significant impact on the outcome.Conclusion Rivaroxaban has more economic advantages than warfarin in the treatment of non valvular atrial fibrillation.

关 键 词：利伐沙班 华法林 非瓣膜性心房颤动 马尔科夫模型 药物经济学 

分 类 号：R541.7[医药卫生—心血管疾病] R956[医药卫生—内科学]