2020 年第 11 期 第 15 卷

非瓣膜性心房颤动患者使用不同抗凝药物的药物经济学系统评价

Pharmacoeconomic systematic review of different anticoagulant drugs used in patients with nonvalvular atrial fibrillation

作者：杨志勇1余萍1李刚2

英文作者：Yang Zhiyong1 Yu Ping1 Li Gang2

单位：1电子科技大学医学院2018级药学专业在读硕士研究生，成都610054；2四川省医学科学院·四川省人民医院药学部，成都610072 

英文单位：1Pharmacy Graduate Student 2018 School of Medicine University of Electronic Science and Technology of China Chengdu 610054 China; 2Department of Pharmacy Sichuan Academy of Medical Sciences Sichuan Provincial People′s Hospital Chengdu 610072 China

关键词：非瓣膜性心房颤动；抗凝药物；经济学；系统评价

英文关键词：Nonvalvularatrialfibrillation;Anticoagulantdrugs;Economics;Systematicreview 

• 摘要：

• 目的 系统评价华法林及新型口服抗凝药物（NOACs）在治疗非瓣膜性心房颤动中的经济性。方法 计算机检索中国知网、万方数据库、Pubmed、Embase、The Cochrane Library等数据库，收集使用抗凝药物治疗非瓣膜性心房颤动的经济学评价研究。根据标准，由2名研究员独立筛选文献，再用综合卫生经济评估报告标准（CHEERS）量表对筛选后的文献进行质量评价，检索时限为2010年1月至2020年6月。结果 共纳入15项研究，都是成本效果研究，其中5篇为中文文献，10篇为英文文献；14篇为高质量文献，1篇为一般质量文献；均采用Markov模型且进行了敏感性分析。纳入的5篇中文文献表明，在中国大部分地区华法林较NOACs具有成本效果优势，有1篇文献表明，在深圳阿哌沙班较华法林具有成本效果优势。10篇英文文献中有9篇表明NOACs具有成本效果优势，另有1篇来自于泰国的文献表明，华法林较达比加群酯（110/150 mg）、利伐沙班、阿哌沙班、依多沙班均具有成本效果优势。结论 目前我国大部分地区治疗非瓣膜性心房颤动的抗凝药物中，还是华法林具有成本效果优势，仅在个别城市NOACs才体现出成本效果优势。

• Objective To evaluate the economics of warfarin and new oral anticoagulants (NOACs) in the treatment of nonvalvular atrial fibrillation.Methods Data was searched in China National Knowledge Infrastructure, Wanfang data, Pubmed, Embase, The Cochrane Library and other databases to collect economic evaluation of the use of anticoagulant drugs to treat non-valvular atrial fibrillation. According to the criteria, the literature was selected independently by 2 researchers, and then the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) scale was used to evaluate the quality of the selected literature. The retrieval time was from January 2010 to June 2020.Results A total of 15 studies were included, all of which were cost-effectiveness studies, including 5 Chinese documents and 10 English documents. There were 14 high-quality documents, and 1 of general quality. Markov model was used and sensitivity analysis was carried out. Five Chinese literatures showed that warfarin was more cost-effective than NOACs in most areas of China; one literature showed that apixaban was more cost-effective than warfarin in Shenzhen. Nine of the 10 English literatures showed that NOACs had cost-effective advantages, one literature from Thailand showed that warfarin had a cost-effective advantage than dabigatran etexilate (110/150 mg), rivaroxaban, apixaban, edoxaban. Conclusions At present, warfarin has the cost-effective advantage among the anticoagulant drugs for the treatment of nonvalvular atrial fibrillation in China. NOACs only show the cost-effective advantage in certain cities.