Health Technology Evaluation Of Four New Oral Anticoagulants

Objective: In this study,we will use the HTA method,based on the policy and clinical needs,initially form the drug evaluation report on NOAC,in order to provide evidence-based suggestions for the government and medical institutions in policy-making and drug selection,and promote rational drug use.Methods: Articles published from January 2017 to November 2020 in the databases of Pub Med,EMBASE,Cocharane,CNKI,VIP,Wanfang and other Chinese and English databases,as well as INANYA,HTAI,ISTAHC and other databases related to health technology assessment.The effectiveness,safety and economy of three kinds of NOAC in the treatment of NVAF were included.The quality of the studies meeting the inclusion and exclusion criteria was evaluated and the basic characteristics were described.The bias risk of the related randomized controlled trials and random cohort studies was evaluated.The value of the statistical risk index was used as the effect index,and the interval estimation was expressed by 95% CI.Result:1.Four medicine articles of apixaban,dabigatran,edoxaban and rivaroxaban were collected,and 2488,2118,1470 and 2059 articles were collected respectively.According to the inclusion and exclusion criteria,12,17,6 and 12 articles were included respectively.Nine SR/Meta-analyses,one pharmacoeconomic study and two randomized controlled trials were included in the study.Six SR/Meta-analyses,two pharmacoeconomic studies,eight randomized controlled trials and one HTA were included in the literature.The basic information of the included articles of edoxaban was 2 SR/Meta analysis,2 pharmacoeconomic studies and 2 randomized controlled trials.The basic information of the included articles of rivaroxaban was 4 SR/Meta analysis,3 pharmacoeconomic studies,5 randomized controlled trials and 1 HTA.2.Evaluation of effectiveness and safety: Compared with warfarin and other DOACs,6 articles indicated that apixaban could reduce the risk of stroke / SE,3 articles indicated that there was no significant difference,and 11 articles indicated that apixaban could reduce the risk of bleeding and mortality.Compared with warfarin and other NOACs,dabigatran had 1 article indicating that it could reduce the risk of stroke / SE,3 articles indicating no significant difference,1 article indicating that dabigatran was worse than rivaroxaban in reducing the risk of stroke / SE,6 articles indicating that dabigatran could reduce the risk of bleeding and mortality,and 1 article indicating no significant difference.Compared with warfarin and other NOACs,there was one article that showed that it could reduce the risk of stroke / SE,three articles that showed no significant difference,and the incidence of adverse reactions was similar;at the same time,there were two articles that showed that it could reduce the risk of bleeding,one article that showed no significant difference,and one article that showed that it had lower mortality.Compared with warfarin or other NOACs,rivaroxaban could reduce the risk of stroke / Se in 3 articles,and there was no significant difference in 4 articles.Compared with warfarin,rivaroxaban had lower risk of is and higher risk of is than dabigatran.At the same time,rivaroxaban could reduce the risk of bleeding in 4 articles,and there was no significant difference in 1article.3.Economic evaluation: An economic study conducted in Thailand for one year found that apixaban was more cost-effective.Three economic studies conducted in the Netherlands,the United States and China show that dabigatran is more cost-unility.One economic study in China shows that edoxaban is more cost-effectiveness,and two studies in Thailand and Spain show that edoxaban is more cost-effectiveness.Three economic studies in Japan,Guangdong and the United States show that rivaroxaban is more cost-effectiveness.Conclusion: Under different administration methods and doses,four kinds of NOAC have the same ability to reduce stroke /SE risk as warfarin,and even have better effect.At the same time,the incidence of adverse reactions is also lower,and they also have better results in reducing bleeding or mortality.Economic evaluation also has similar or better cost-effectiveness.Therefore,HTA can help the government and hospitals to judge that NOAC is effective,safe and economical in the prevention and treatment of NVAF,and can be used.