新しい抗凝固薬を巡る話題「心房細動に伴う血栓塞栓症予防と新しい抗凝固薬の役割」４．心房細動治療における抗凝固薬の費用対効果

概要

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Oral anticoagulant reduces the risk of ischemic stroke in patients with atrial fibrillation (AF), but increases the risk of bleeding. The use of oral anticoagulant adds to the cost of existing therapy, but if the benefit of the reduction in incidence of ischemic stroke exceeds the incremental cost of additional oral anticoagulant, the total health expenditure of the country will decrease. The first part of this article explains the method used for calculating the incremental cost-effectiveness ratio (ICER), the theory of quality-adjusted life year (QALY) and Makov cycles. The latter part describes the application of ICER in patients with AF receiving warfarin (warfarin vs. aspirin vs. no antithrombotic agents) in computer simulations followed by the introduction of recently published articles regarding the ICER of dabigatran vs. warfarin. Any health intervention which has an incremental cost of more than US$50,000 per additional QALY gained is likely to be rejected by the healthcare administration of the country. Warfarin vs. aspirin or dabigatran vs. warfarin was well within such a range and regarded as cost-effective. The sensitivity test revealed that the merit depends heavily on the price of dabigatran.
一般社団法人日本臨床薬理学会の論文