本論文深入探討了新型口服抗凝血劑（NOACs）在台灣治療血管疾病方面的應用。論文結構分為三個主要章節，每章聚焦於NOACs使用的特定方面。第二章提供了利rivaroxaban與aspirin的經濟比較分析。第三章呈現了rivaroxaban與warfarin在治療靜脈血栓栓塞（VTE）方面的有效性和安全性比較數據。最後，第四章匯總了NOACs在癌症相關靜脈血栓栓塞病例中的臨床結果。

第二章分析了在台灣慢性心血管疾病患者中，低劑量rivaroxaban與aspirin聯合療法相對於單獨使用aspirin進行次級預防的成本效益比較。研究利用COMPASS試驗數據建立馬爾可夫模型，預測了30年期間的健康和經濟結果。研究發現，聯合療法可增加0.47個品質調整生命年（QALYs），但同時會增加39,226美元的費用，導致每增加一個QALY的增量成本效果比（ICER）為83,459美元。研究結論指出，該療法超過了台灣的支付意願閾值。敏感性分析進一步表明，藥品定價是影響經濟評估的關鍵因素。

第三章進行了一項全國性的回顧性世代研究，比較了rivaroxaban與warfarin在台灣靜脈血栓栓塞患者中的安全性和有效性。研究利用全民健康保險資料庫追蹤了639位患者，其中包括183位rivaroxaban使用者和456位warfarin使用者。研究結果顯示，與肝素/低分子量肝素（LMWH）後續使用warfarin相比，rivaroxaban並未顯著降低復發性VTE的風險（HR 0.72，CI 0.37-1.37，p=0.31）或死亡率（HR 0.86，CI 0.49-1.50，p=0.59）。在出血風險方面，rivaroxaban與warfarin之間的重大出血風險相當（HR 1.80，CI 0.39-8.29，p=0.45）。然而，由於樣本數有限，研究建議未來需要更大規模的研究來探討不同特定因素的影響。

第四章提供了一項關於在癌症患者中使用NOACs治療靜脈血栓栓塞的系統性回顧和統合分析。分析包含了12個隨機對照試驗，結果顯示NOACs相較於低分子量肝素可降低34%的靜脈血栓栓塞復發風險（RR 0.66，95% CI 0.52-0.83，p=0.0004），且不會顯著增加重大出血風險。報告指出NOACs與LMWH的療效相當，復發率分別為5.66%和8.83%，重大出血率分別為5.00%和3.98%。研究結論表明，與LMWH相比，NOACs（尤其是凝血因子Xa抑制劑）在癌症患者中能更有效地降低靜脈血栓栓塞的復發風險，同時保持相當的安全性。

This thesis examines the use of Novel Oral Anticoagulants (NOACs) in treating vascular diseases in Taiwan. The study is structured into three main chapters, each focusing on a specific aspect of NOAC use. Chapter 2 provides an economic analysis comparing rivaroxaban with aspirin. Chapter 3 presents comparative effectiveness and safety data between rivaroxaban and warfarin for Venous Thromboembolism (VTE) treatment. Finally, Chapter 4 aggregates clinical outcomes of NOACs in cancer associated VTE cases.

Chapter 2 investigates the cost-effectiveness of combining low-dose rivaroxaban and aspirin against aspirin alone for secondary prevention in Taiwanese patients with chronic cardiovascular diseases. Using a Markov model with data from the COMPASS trial, the study examines health and economic outcomes over a projected 30-year horizon. The findings reveal that the combination therapy leads to an increase of 0.47 Quality-Adjusted Life Years (QALYs) but incurs an additional lifetime cost of $39,226, resulting in an Incremental Cost-Effectiveness Ratio (ICER) of $83,459 per QALY gained. The study concludes that this therapy exceeds Taiwan's willingness-to-pay threshold, suggesting limited cost-effectiveness. Sensitivity analysis identifies drug pricing as a critical factor influencing the economic evaluation.

Chapter 3 presents a nationwide retrospective cohort study comparing the safety and effectiveness of rivaroxaban to warfarin in the Taiwanese VTE patient population. Utilizing the comprehensive National Health Insurance database, the study follows 639 patients, including 183 rivaroxaban users and 456 warfarin users. The results indicate that rivaroxaban did not significantly reduce the risk of recurrent VTE (HR, 0.72; CI, 0.37 to 1.37; p = 0.31) or mortality (HR, 0.86; CI, 0.49 to 1.50; p = 0.59) compared with heparin/LMWH followed by warfarin. The risk of major bleeding was comparable between the rivaroxaban and warfarin groups (HR, 1.80; CI, 0.39 to 8.29; p = 0.45). However, due to the limited sample size, the study suggests that future research with larger sample sizes is needed to investigate the impact of different specific factors.

Chapter 4 provides a systematic review and meta-analysis on the use of NOACs for venous thromboembolism in cancer patients. The analysis, which includes 12 randomized controlled trials, shows that NOACs reduced the recurrence risk of venous thromboembolism by 34% (RR 0.66, 95% CI 0.52-0.83, p=0.0004) compared to Low Molecular Weight Heparin (LMWH), without significantly increasing the risk of major bleeding. The report indicates comparable efficacy between NOACs and LMWH, with recurrence rates of 5.66% and 8.83%, respectively, and major bleeding rates of 5.00% and 3.98%, respectively. The study concludes that compared to LMWH, NOACs, especially Factor Xa inhibitors, are more effective in reducing the risk of recurrent venous thromboembolism in cancer patients, with comparable safety profiles.

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