Cost-effectiveness for prevention of thromboembolism by anticoagulants in non-valvular atrial fibrillation: additional analysis from the Hokuriku-Plus AF Registry.
Cost-effectiveness for prevention of thromboembolism by anticoagulants in non-valvular atrial fibrillation: additional analysis from the Hokuriku-Plus AF Registry.
复制标题
非瓣膜性房颤抗凝剂预防血栓栓塞的成本效益：Hokuriku-Plus AF 登记处的额外分析。
DOI：
10.1007/s00380-018-01333-6
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Hayashi K; Hokuriku?plus AF Registry Research Group.
中科院分区：
文献类型：
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作者：
Yamagishi M;Tsuda T;Kato T;Furusho H;Hayashi K; Hokuriku?plus AF Registry Research Group.
虽然直接口服抗凝剂（DOAC）治疗非瓣膜性房颤（AF）的获益已得到充分证明，但在现实世界的临床实践中，关于DOAC和华法林使用之间的成本效益的数据很少。因此，我们估计了日本授权心脏病专家治疗AF的总费用。我们研究了连续617例接受授权心脏病专家咨询的抗凝非瓣膜性AF患者（418例男性，平均年龄68.8岁，54%华法林）。华法林治疗范围内的平均时间为71.8%。在这些条件下，我们计算了抗凝剂，实验室检查，并在随访期间因血栓栓塞或出血住院的费用为3.1年。26例患者（4.2%，1.3/100人-年）发生血栓栓塞，20例患者（3.2%，1.0/100人-年）发生出血事件。两组之间血栓栓塞（log rankP= 0.16）或出血事件（log rankP= 0.83）的发生率无显著差异。重要的是，华法林组在药物、医疗检查和住院费用方面的费用低于DOAC组（117，361 ± 743，710日元/年vs. 310，436 ± 1，075，639日元/人，P= 0.009）。这些结果表明，在日本，由授权心脏病专家治疗AF时，华法林的总成本可能低于DOAC，尽管需要进一步的前瞻性随机成本计算，包括出院后护理费用。
Although benefits of direct oral anticoagulants (DOAC) for treatment of non-valvular atrial fibrillation (AF) were well demonstrated, few data exist regarding cost-effectiveness between DOAC and warfarin uses in real-world clinical practice. Therefore, we estimated total cost of treatment for AF by authorized cardiologists in Japan. We studied consecutive 617 anticoagulated non-valvular AF patients (418 men, mean age 68.8, 54% warfarin) consulted by authorized cardiologists. The mean time in therapeutic range of warfarin was 71.8%. Under these conditions, we calculated the cost of anticoagulants, laboratory examination, and hospitalization due to thromboembolism or bleeding during follow-up for 3.1 years. Thromboembolism occurred in 26 patients (4.2%, 1.3/100 person-year) and hemorrhagic events in 20 patients (3.2%, 1.0/100 person-year). There was no significant difference in the occurrence rate of thromboembolism (log rankP= 0.16) or hemorrhagic events (log rankP= 0.83) between these two groups. Importantly, warfarin group showed lower cost than DOAC group (117,361 ± 743,710 yen/year vs. 310,436 ± 1,075,639 yen/person,P= 0.009) in terms of cost including drug, medical check, and hospitalization. These results demonstrate that the total cost with warfarin can be lower than DOAC in treatment for AF by authorized cardiologists in Japan, although further prospective randomized cost calculation is necessary including post-discharge care fee.