Cost-effective analysis of LAAC and oral anticoagulants in the prevention of stroke in patients with atrial fibrillation / 中国实用内科杂志

ABSTRACT

OBJECTIVE: To study the cost-effectiveness of left atrial appendage occlusion(LAAC), rivaroxaban and warfarin in the prevention of stroke in patients with atrial fibrillation, in order to explore the most appropriate economical medication model. METHODS: A total of 156 NVAF patients treated in the First Affiliated Hospital of Dalian Medical University from July2016 to June 2018 were studied; they were divided into group A(LAAC), group B(rivaroxaban)and group C(warfarin)by random digital method.Markov model was used to analyze the drug economy of three methods to prevent stroke in patients with atrial fibrillation within one year, and sensitivity analysis was conducted to verify the stability of the results. RESULTS: The total cost of treatment in group C was significantly lower than that in the other two groups, while in group A it was significantly higher than in the other two groups, with statistical significance(P<0.05). ICER(A vs. B)was 91242.31 yuan/QALY,ICER(B vs. C)was 96706.25 yuan/QALY, and ICER(A vs. C)was 93323.81 yuan/QALY. So the drug economy of group A was better than that of the other two groups, and group B was better than group C. When the sensitive indicators selected changed, there was still a statistical difference in the total cost among the three groups(P<0.05), which indicated that the results of this study were credible. CONCLUSION: Compared with warfarin and rivaroxaban, LAAC may have more pharmacoeco-nomic effects on preventing stroke in patients with atrial fibrillation, but further studies with large sample sizes and longer follow-up cycles are needed.