PHÂN TÍCH CHI PHÍ-HIỆU QUẢ CỦA CÁC THUỐC CHỐNG ĐÔNG THẾ HỆ MỚI TRONG ĐIỀU TRỊ THUYÊN TẮC HUYẾT KHỐI TĨNH MẠCH VÀ PHÒNG NGỪA BIẾN CỐ TÁI PHÁT TẠI VIỆT NAM

Abstract

Introduction: Venous thromboembolism (VTE) is one of the leading causes of death in cardiovascular diseases, ranking only behind acute myocardial infarction and stroke. Currently, novel oral anticoagulants (NOACs) have been introduced for the treatment of VTE and the prevention of recurrent events. However, the high cost of these drugs poses significant challenges for patients in accessing treatment. Research Methods: A Markov model was used, with data collected from clinical studies, literature reviews, and expert consultations, based on the perspective of the health insurance payer. Results: The study compared the effectiveness (QALY, LYG) and treatment costs of apixaban, rivaroxaban, dabigatran, LMWH/VKA, and heparin/VKA in the treatment of VTE. The results showed that apixaban outperformed rivaroxaban and dabigatran, providing higher effectiveness while saving treatment costs by 1.93 million VND and 2.32 million VND, respectively. Rivaroxaban was found to be superior to dabigatran. Furthermore, within Vietnam’s willingness-to-pay (WTP) threshold (305.7 million VND/QALY), apixaban was cost-effective compared to LMWH/VKA and heparin/VKA. In contrast, rivaroxaban was not cost-effective, and dabigatran was dominated by LMWH/VKA and heparin/VKA (i.e., it was less effective and more expensive). Conclusion: From the perspective of the health insurance payer, compared to the WTP threshold (305.7 million VND/QALY), apixaban is cost-effective compared to VKA and demonstrates superiority over rivaroxaban and dabigatran in the treatment of systemic embolism in Vietnam.