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tem acompanhado o crescimento da despesa em sa&#250;de<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Todo este investimento na sa&#250;de traduz&#8208;se numa melhoria dos seus indicadores&#44; onde se destaca o aumento da esperan&#231;a m&#233;dia de vida<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">N&#227;o obstante&#44; existe uma maior consciencializa&#231;&#227;o de que os recursos em sa&#250;de dispon&#237;veis para os procedimentos m&#233;dicos&#44; incluindo a terap&#234;utica farmacol&#243;gica&#44; s&#227;o cada vez mais limitados&#46; Como tal&#44; as avalia&#231;&#245;es econ&#243;micas visam racionalizar estes recursos direcionando&#8208;os eficientemente para onde s&#227;o mais necess&#225;rios&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">&#201; neste contexto que surge a an&#225;lise custo&#8208;efetividade&#44; uma ferramenta que visa comparar o custo de uma interven&#231;&#227;o de sa&#250;de com os ganhos em sa&#250;de esperados<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Esta interven&#231;&#227;o pode ser entendida como qualquer atividade que usa recursos financeiros ou humanos e que tem como objetivo melhorar a sa&#250;de&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A fibrilha&#231;&#227;o auricular &#40;FA&#41; &#233; a arritmia mais frequente na pr&#225;tica clinica<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; O peso que esta patologia representa&#44; em termos de morbilidade e mortalidade&#44; mas tamb&#233;m em termos econ&#243;micos&#44; &#233; substancial&#46; A preven&#231;&#227;o do acidente vascular cerebral &#40;AVC&#41; pela administra&#231;&#227;o de anticoagulantes &#233; um dos principais objetivos no tratamento de doentes com FA<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; A FA est&#225; associada a um estado pr&#243;&#8208;tromb&#243;tico&#44; resultante da estase sangu&#237;nea intra&#8208;auricular e de doen&#231;a card&#237;aca estrutural&#44; conduzindo a uma predisposi&#231;&#227;o para a forma&#231;&#227;o de trombos&#44; particularmente no ap&#234;ndice auricular esquerdo&#46; Este estado pr&#243;&#8208;tromb&#243;tico predisp&#245;e ao embolismo card&#237;aco&#44; fazendo com que os doentes tenham um risco cerca de cinco vezes superior de AVC e embolismo sist&#233;mico&#44; em compara&#231;&#227;o com os indiv&#237;duos sem FA<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; A terap&#234;utica com anticoagulantes &#233; a pedra angular para a preven&#231;&#227;o e tratamento das doen&#231;as tromboemb&#243;licas<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Os novos anticoagulantes orais &#40;ACO&#41; representam um novo paradigma&#44; j&#225; que apresentam uma maior facilidade de uso&#44; bem como perfis farmacol&#243;gicos mais favor&#225;veis&#46; T&#234;m ainda um in&#237;cio de a&#231;&#227;o mais r&#225;pido e uma resposta anticoagulante mais previs&#237;vel&#44; conseguindo eliminar a necessidade de serem monitorizados<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Foram realizados ensaios cl&#237;nicos de fase <span class="elsevierStyleSmallCaps">III</span> com quatro agentes para a preven&#231;&#227;o do AVC em doentes com FA n&#227;o valvular&#44; que revelaram uma diminui&#231;&#227;o ou taxas semelhantes de tromboembolismo&#44; hemorragia grave e efeitos adversos quando comparados com varfarina ou aspirina<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;12</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Como resultado&#44; uma aplica&#231;&#227;o ampla destes novos agentes pode conduzir a um aumento significativo dos doentes corretamente anticoagulados&#44; muitos dos quais n&#227;o recebiam sequer qualquer terap&#234;utica devido &#224;s inconveni&#234;ncias e desvantagens dos antagonistas da vitamina K &#40;AVK&#41;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Todavia&#44; sem meios adequados de controlo do n&#237;vel de coagula&#231;&#227;o&#44; a seguran&#231;a e efic&#225;cia da aplica&#231;&#227;o destes novos f&#225;rmacos a longo prazo&#44; o tratamento de doentes com m&#250;ltiplas comorbilidades e polimedicados&#44; exigir&#225; estudos observacionais mais extensos<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; A falta de ant&#237;dotos&#44; de testes laboratoriais fi&#225;veis&#44; de evid&#234;ncia de seguran&#231;a na pr&#225;tica cl&#237;nica do mundo real e o custo elevado t&#234;m sido apontados como limita&#231;&#245;es importantes &#224; sua utiliza&#231;&#227;o generalizada&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O estudo <span class="elsevierStyleBold">A</span> Review of Cost E<span class="elsevierStyleBold">FF</span>ectiveness of Novel <span class="elsevierStyleBold">OR</span>al Anticoagulant <span class="elsevierStyleBold">D</span>rugs &#40;AFFORD&#41; &#233; uma revis&#227;o sistem&#225;tica dos estudos de custo&#8208;efetividade dos novos ACO na preven&#231;&#227;o do AVC na FA&#44; com descri&#231;&#227;o dos resultados principais&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Identifica&#231;&#227;o de estudos</span><p id="par0110" class="elsevierStylePara elsevierViewall">A identifica&#231;&#227;o de estudos foi conseguida atrav&#233;s do uso de uma frase de pesquisa&#44; &#171;&#40;&#91;adults AND humans&#93; AND &#91;&#171;new oral anticoagulants&#187; OR &#171;new oral anticoagulation&#187; OR &#171;novel oral anticoagulants&#187; OR &#171;novel oral anticoagulation&#187; OR &#171;newer oral anticoagulants&#187; OR &#171;newest oral anticoagulants&#187; OR &#171;new generation oral anticoagulants&#187; OR &#171;oral direct thrombin inhibitor&#42;&#187; OR &#171;new oral thrombin inhibitor&#42;&#187; OR &#171;oral factor Xa inhibitor&#42;&#187; OR &#171;orally active factor Xa inhibitor&#187; OR &#171;orally active thrombin inhibitor&#187; OR rivaroxaban&#42; OR dabigatran&#42; OR apixaban&#42; OR edoxaban&#42;&#93; AND &#91;&#171;cost&#8208;effectiveness analysis&#187; OR &#171;cost&#8208;effectiveness study&#187; OR &#171;cost&#8208;effective&#187; OR &#171;cost&#8208;effectiveness&#187;&#93; AND &#91;&#171;atrial fibrillation&#93;&#41;&#187;&#44; que foi utilizada em cinco bases de dados diferentes e consensuais no meio cient&#237;fico &#8211; <span class="elsevierStyleItalic">Pubmed&#44; Embase&#44; Scopus&#44; Cochrane</span> e <span class="elsevierStyleItalic">Web of Knowledge</span> &#8211; para que pudessem ser encontrados estudos que estivessem integrados no objetivo deste estudo&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Pela pesquisa descrita anteriormente foram obtidos 533 estudos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#44; que foram analisados pela leitura dos resumos e dos manuscritos&#44; quando apropriado&#44; com o objetivo de selecionar os estudos realizados em popula&#231;&#245;es adultas que comparassem os novos ACO e os anticoagulantes tradicionais&#44; atrav&#233;s de uma an&#225;lise de custo&#8208;efetividade&#46; Foram exclu&#237;dos 414 estudos que n&#227;o reuniam as condi&#231;&#245;es descritas e 52 estudos publicados somente sob a forma de resumo&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Ap&#243;s elimina&#231;&#227;o dos estudos duplicados foram selecionados 23 artigos&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Al&#233;m destes&#44; foram selecionados mais quatro estudos publicados sob a forma de artigo que n&#227;o apareceram na pesquisa nas bases de dados&#44; quando se utilizou aquela frase de pesquisa&#46; Tr&#234;s estudos foram encontrados nas refer&#234;ncias bibliogr&#225;ficas dos manuscritos analisados e outro foi encontrado em pesquisas anteriores no <span class="elsevierStyleItalic">Pubmed&#46;</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Colheita de dados</span><p id="par0130" class="elsevierStylePara elsevierViewall">Os dados colhidos relativos ao modelo farmacoecon&#243;mico inclu&#237;ram&#58; 1&#41; o pa&#237;s&#59; 2&#41; as compara&#231;&#245;es prim&#225;rias &#8211; o novo ACO estudado e as doses&#44; o anticoagulante comparador e os respetivos custos di&#225;rios&#59; 3&#41; a estrutura do modelo e assun&#231;&#245;es&#44; como modelos progenitores&#44; a perspetiva do estudo&#59; 4&#41; os resultados do modelo incluindo o custo incremental&#44; os anos de vida ajustados para a qualidade &#40;AVAQ&#41; e o r&#225;cio custo&#8208;efetividade incremental &#40;RCEI&#41;&#44; o limite pr&#233;&#8208;fixado &#224; disponibilidade a pagar &#40;LPFDP&#41; por ano de vida ou por AVAQ ganho e as an&#225;lises de sensibilidade&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Avalia&#231;&#227;o da qualidade dos estudos</span><p id="par0135" class="elsevierStylePara elsevierViewall">A qualidade dos estudos foi avaliada pelos investigadores&#44; atrav&#233;s da disponibilidade dos dados pr&#233;&#8208;definidos nos modelos dos estudos selecionados&#44; que est&#227;o inclu&#237;dos nos crit&#233;rios da escala <span class="elsevierStyleItalic">Quality of Health Economic Studies</span><a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lise estat&#237;stica</span><p id="par0140" class="elsevierStylePara elsevierViewall">A natureza descritiva da presente revis&#227;o sistem&#225;tica n&#227;o se enquadrou numa an&#225;lise estat&#237;stica formal&#46; As caracter&#237;sticas e os resultados dos modelos farmacoecon&#243;micos selecionados foram apresentados de forma qualitativa&#44; com suporte nos valores de custo incremental&#44; AVAQ&#44; RCEI&#44; LPFDP e percentagem nas an&#225;lises de sensibilidade&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Para cada f&#225;rmaco foram calculadas as m&#233;dias e os desvios padr&#227;o dos RCEI por AVAQ&#44; ap&#243;s convers&#227;o em euros&#44; quando apropriado&#44; utilizando a taxa cambial em 16&#47;05&#47;2014&#58; 1 d&#243;lar americano &#40;USD&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;7321 euros&#59; 1 d&#243;lar canadiano &#40;CAD&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;6736 euros&#59; 1 libra esterlina<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;2267 euros&#59; 1 franco su&#237;&#231;o &#40;CFH&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;819 euros&#59; 1 rand sul&#8208;africano &#40;ZAR&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0708 euros&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0150" class="elsevierStylePara elsevierViewall">Dos 27 estudos selecionados na pesquisa efetuada &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;40</span></a>&#44; a maioria &#233; oriunda da Europa&#44; com 11 estudos<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;18&#44;19&#44;21&#44;22&#44;24&#44;26&#8211;29&#44;33</span></a> e dos Estados Unidos da Am&#233;rica &#40;EUA&#41;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;16&#44;20&#44;31&#44;32&#44;34&#8211;36&#44;38&#44;39</span></a>&#44; com dez estudos&#46; Com origem no Canad&#225; foram encontrados tr&#234;s estudos<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;27&#44;30</span></a> e ainda dois da China<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;30</span></a> e outro da &#193;frica do Sul<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">As perspetivas mais seguidas nestes estudos foram do ponto de vista do sistema de sa&#250;de &#40;11 estudos&#41;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;19&#44;21&#44;24&#44;26&#44;29&#44;33&#44;35</span></a>&#44; do pagador &#40;nove estudos&#41;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;25&#8211;27&#44;30&#44;33&#44;37&#44;39&#44;40</span></a> e da sociedade &#40;tr&#234;s estudos&#41;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;36&#44;38</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">O modelo escolhido pela grande maioria dos estudos &#40;93&#37;&#41; foi o modelo de Markov<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;17&#44;19&#8211;21&#44;23&#8211;40</span></a>&#46; Al&#233;m deste modelo&#44; um estudo utilizou um modelo de simula&#231;&#227;o discreta de eventos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> e foi realizado um estudo observacional prospetivo<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">O dabigatrano foi o f&#225;rmaco mais estudado nesta indica&#231;&#227;o espec&#237;fica e foi analisado individualmente em 67&#37; dos estudos apurados<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;31</span></a>&#46; O apixabano foi analisado de forma particular em tr&#234;s estudos<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#8211;36</span></a> e o rivaroxabano em dois<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;33</span></a>&#46; Todos os restantes compararam pelo menos dois dos novos anticoagulantes com a varfarina<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#8211;40</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">O comparador mais utilizado foi a varfarina&#44; na sua dose ajustada&#44; sendo que a maior parte considerou o impacto da variabilidade no controlo do INR nos seus resultados&#46; Apenas os estudos de Pletscher et al&#46;&#44; que utilizou o fenprocoumon<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#44; e o de Lee et al&#46;&#44; que utilizou a aspirina<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#44; n&#227;o utilizaram a varfarina como comparador&#46; O primeiro estudo utilizou o fenprocoumon por ser o AVK mais utilizado na Su&#237;&#231;a&#44; pa&#237;s de onde &#233; oriundo este estudo&#46; O segundo estudo baseou&#8208;se nos resultados do ensaio cl&#237;nico AVERROES&#44; que comparou o apixabano com a aspirina em doentes com FA intolerantes aos AVK<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Em geral&#44; todos os estudos apontaram para a exist&#234;ncia de custo&#8208;efetividade por parte dos novos ACO&#44; uma vez que os RCEI ficaram bastante abaixo dos LPFDP&#44; tra&#231;ados pelos autores do estudo&#44; mas em geral concordantes com os definidos pelos sistemas de sa&#250;de espec&#237;ficos&#44; como limite para a comparticipa&#231;&#227;o ou reembolso &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a>&#41;&#46; A m&#233;dia dos RCEI por AVAQ foram de 30 405<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16 101 euros para o dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg&#44; 17 566<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16 902 euros para o dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&#44; 8102<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3252 euros para o dabigatrano ajustado &#224; idade&#44; 11 897<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3341 euros para o apixabano e 17 960<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 005 euros para o rivaroxabano&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">A tend&#234;ncia que se observou nos estudos em que o dabigatrano foi analisado em separado &#233; que este anticoagulante na dose de 150<span class="elsevierStyleHsp" style=""></span>mg foi mais custo&#8208;efetivo&#44; apesar da variabilidade verificada nas diversas an&#225;lises de sensibilidade&#46; O mesmo se observou na dose ajustada &#224; idade &#40;150<span class="elsevierStyleHsp" style=""></span>mg 2<span class="elsevierStyleHsp" style=""></span>x&#47;dia para os doentes com idade inferior a 80 anos e 110<span class="elsevierStyleHsp" style=""></span>mg 2<span class="elsevierStyleHsp" style=""></span>x&#47;dia para os restantes&#41; que demonstrou custo&#8208;efetividade em todas as an&#225;lises que a inclu&#237;ram<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;17&#44;21&#44;25&#8211;27&#44;29&#44;40</span></a>&#46; A dose de 110<span class="elsevierStyleHsp" style=""></span>mg al&#233;m de ter&#44; regra geral&#44; um custo incremental mais elevado&#44; n&#227;o foi custo&#8208;efetiva em 43&#37; dos modelos que a analisaram em separado<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;23&#44;37</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Foi tamb&#233;m inclu&#237;da na revis&#227;o sistem&#225;tica uma an&#225;lise custo&#8208;efetividade realizada em Portugal&#44; sobre a utiliza&#231;&#227;o do dabigatrano na preven&#231;&#227;o do AVC na FA&#44; que utilizou nos seus c&#225;lculos&#44; quer dados econ&#243;micos quer custos de terap&#234;utica praticados no nosso pa&#237;s&#46; Esta an&#225;lise concluiu de forma clara que a utiliza&#231;&#227;o do dabigatrano na pr&#225;tica cl&#237;nica portuguesa &#233; custo&#8208;efectiva<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">No caso do rivaroxabano&#44; como anteriormente referido&#44; foram analisados dois estudos&#44; um norte&#8208;americano<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> e outro belga<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#44; e ambos mostraram que este agente foi custo&#8208;efetivo na maioria das simula&#231;&#245;es realizadas nas an&#225;lises de sensibilidade&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">No que se refere aos tr&#234;s estudos espec&#237;ficos do apixabano&#44; todos realizados nos EUA&#44; este associou&#8208;se a poupan&#231;a no modelo que o comparou com a aspirina<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> e noutro modelo que usou a varfarina como comparador<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#46; No terceiro modelo revelou custo&#8208;efetividade em 62&#37; das simula&#231;&#245;es nas an&#225;lises de sensibilidade<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Nos estudos em que os tr&#234;s novos ACO foram comparados em simult&#226;neo<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#8211;39</span></a>&#44; os resultados apontam para que o apixabano seja o mais custo&#8208;efetivo&#44; seguido pelo dabigatrano e rivaroxabano&#46; Nos modelos de Coyle et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> e de Harrington et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> a conclus&#227;o &#233; suportada pelo custo incremental e pela an&#225;lise da sensibilidade&#46; No modelo de Deitelzweig et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> o custo incremental foi negativo para os tr&#234;s ACO&#44; indicando gera&#231;&#227;o de poupan&#231;a&#44; mas o valor foi mais elevado para o apixabano&#46; No modelo de Kansal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> para a realidade canadiana o dabigatrano foi mais custo&#8208;efetivo do que o rivaroxabano &#40;RCEI 6889CAN&#47;AVAQ vs&#46; 22475CAN&#47;AVAQ&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discuss&#227;o</span><p id="par0205" class="elsevierStylePara elsevierViewall">Os novos ACO mostraram ter vantagens farmacol&#243;gicas quando comparados com os anticoagulantes tradicionais&#44; que se traduziram geralmente em benef&#237;cios cl&#237;nicos nos numerosos ensaios em diversos cen&#225;rios cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;12</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">A presente revis&#227;o sistem&#225;tica surge num contexto em que esta inova&#231;&#227;o farmacol&#243;gica se come&#231;a a manifestar com uma utiliza&#231;&#227;o mais ampla destes novos agentes na pr&#225;tica clinica&#46; Por serem terap&#234;uticas mais dispendiosas&#44; acarretam um maior peso em termos de custos para os sistemas de sa&#250;de e para os seus benefici&#225;rios&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">O estudo AFFORD pretende agregar os estudos de an&#225;lise econ&#243;mica dos novos ACO publicados&#44; para perceber se h&#225; custo&#8208;efetividade&#44; ou seja&#44; se os ganhos em sa&#250;de superam o custo desta nova terap&#234;utica&#46; Este estudo inclui pela primeira vez na metodologia de uma revis&#227;o sistem&#225;tica de an&#225;lises de custo efetividade&#44; o c&#225;lculo da m&#233;dia da sua vari&#225;vel mais importante&#44; o ICER por AVAQ&#44; ap&#243;s convers&#227;o em euros dos estudos referidos a outras moedas&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Estes estudos s&#227;o oriundos de diferentes partes do globo&#44; estando representados pa&#237;ses da Am&#233;rica&#44; Europa&#44; &#193;frica e &#193;sia&#44; que apresentam diferentes modelos econ&#243;micos&#44; diferentes perspetivas econ&#243;micas para a sua realiza&#231;&#227;o&#44; diversos comparadores&#44; pre&#231;os vari&#225;veis das terap&#234;uticas&#44; diferentes formas de apresenta&#231;&#227;o do resultado final e ainda diversos limites de disponibilidade para pagar&#46; Por este motivo&#44; um dos desafios na avalia&#231;&#227;o comparativa dos diferentes modelos consistiu na variabilidade das metodologias utilizadas&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Apesar desta variabilidade&#44; os resultados s&#227;o consistentes e demostraram custo&#8208;efetividade dos novos ACO face &#224;s terap&#234;uticas convencionais mais utilizadas&#44; neste caso a varfarina na preven&#231;&#227;o do AVC na FA&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Nesta revis&#227;o sistem&#225;tica&#44; os novos ACO que mais se destacam s&#227;o o dabigatrano e o apixabano&#46; O primeiro &#233; o que possui maior n&#250;mero de estudos&#44; relacionado com o facto de ser o mais antigo&#46; &#201; importante mencionar que os resultados dos estudos agora analisados est&#227;o intimamente relacionados com os resultados dos ensaios cl&#237;nicos&#46; No estudo RE&#8208;LY&#44; a utiliza&#231;&#227;o do dabigatrano na FA mostrou superioridade da dose de 150<span class="elsevierStyleHsp" style=""></span>mg em termos de efic&#225;cia e da dose de 110<span class="elsevierStyleHsp" style=""></span>mg na seguran&#231;a&#44; em compara&#231;&#227;o com a varfarina<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; O dabigatrano na dose de 150<span class="elsevierStyleHsp" style=""></span>mg e na dose ajustada &#224; idade foi sempre custo&#8208;efetivo e mostrou superioridade em percentagem elevada&#44; acima de 80&#37;&#44; nas simula&#231;&#245;es das an&#225;lises de sensibilidade&#46; O apixabano mostrou superioridade&#44; tanto em efic&#225;cia como em seguran&#231;a&#44; no estudo ARISTOTLE<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; em compara&#231;&#227;o com a varfarina&#44; e no estudo AVERROES<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; em compara&#231;&#227;o com a aspirina&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">&#201; dif&#237;cil comparar os resultados dos estudos que analisam os tr&#234;s f&#225;rmacos em separado&#44; porque s&#227;o an&#225;lises realizadas a partir de estudos e de ensaios cl&#237;nicos com metodologias diferentes&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Os modelos estudados na preven&#231;&#227;o do AVC na FA adotaram diferentes perspetivas&#44; como pagador&#44; sistema de sa&#250;de ou sociedade&#46; As perspetivas do pagador e do sistema de sa&#250;de podem ser consideradas perspetivas coincidentes&#44; uma vez que a perspetiva do pagador pode incluir companhias de seguros&#44; entidades patronais ou o pr&#243;prio governo que &#233; quem gere o sistema de sa&#250;de na maior parte dos pa&#237;ses&#46; J&#225; a perspetiva da sociedade &#233; mais ampla porque considera o benef&#237;cio para a comunidade como um todo&#46; Teoricamente&#44; todos os custos diretos e indiretos s&#227;o inclu&#237;dos na avalia&#231;&#227;o econ&#243;mica realizada a partir de uma perspetiva social<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">A presente revis&#227;o sistem&#225;tica inclui tr&#234;s estudos<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#8211;39</span></a> em que os novos ACO foram analisados em simult&#226;neo&#44; o que permitiu estabelecer uma hierarquia em termos de desempenho farmacoecon&#243;mico&#46; Embora sejam an&#225;lises tamb&#233;m diferentes entre si&#44; todas apontam um resultado id&#234;ntico&#58; os novos ACO s&#227;o custo&#8208;efetivos e o apixabano &#233; o mais custo&#8208;efetivo&#44; seguido do dabigatrano e do rivaroxabano&#46; No estudo de Deitelzweig et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> &#233; referido que os tr&#234;s t&#234;m um custo incremental negativo pelo que geram poupan&#231;a&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Outro ponto comum entre a maior parte destes estudos &#233; o do modelo utilizado na an&#225;lise econ&#243;mica&#46; O modelo de Markov foi empregue em mais de 90&#37; dos estudos analisados e consiste num modelo estat&#237;stico que permite simular a evolu&#231;&#227;o dos doentes em ciclos de tempo at&#233; ao fim da sua vida&#46; Em cada ciclo temporal &#233; aplicada uma determinada probabilidade de ocorr&#234;ncia mutuamente exclusiva dos eventos mais importantes para a popula&#231;&#227;o em estudo&#46; Podem ser utilizados diferentes desenhos deste modelo e tamb&#233;m diferentes adapta&#231;&#245;es consoante a realidade de cada pa&#237;s ou consoante a orienta&#231;&#227;o do pr&#243;prio estudo econ&#243;mico<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">O estudo AFFORD tem tamb&#233;m algumas limita&#231;&#245;es que devem ser referidas&#46; Desde logo as compara&#231;&#245;es indiretas entre os novos ACO devem ser encaradas com reserva devido &#224;s diferentes metodologias utilizadas nos ensaios cl&#237;nicos de efic&#225;cia e seguran&#231;a&#46; Tamb&#233;m n&#227;o existem guias internacionais padronizadas para a realiza&#231;&#227;o de an&#225;lises econ&#243;micas&#44; o que coloca obst&#225;culos a uma avalia&#231;&#227;o comparativa e precisa entre os diferentes modelos econ&#243;micos<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#46; Esta padroniza&#231;&#227;o &#233; necess&#225;ria&#44; pois a preocupa&#231;&#227;o crescente com a conten&#231;&#227;o de custos e racionaliza&#231;&#227;o dos recursos em sa&#250;de&#44; origina uma prolifera&#231;&#227;o de an&#225;lises econ&#243;micas que&#44; para poderem ser compar&#225;veis&#44; devem obedecer a regras universais&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Outra limita&#231;&#227;o importante que pode ser apontada ao AFFORD &#233; o facto de alguns autores dos estudos inclu&#237;dos nesta revis&#227;o sistem&#225;tica serem funcion&#225;rios dos laborat&#243;rios de onde s&#227;o oriundos os f&#225;rmacos estudados&#44; o que gera potenciais conflitos de interesse&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclus&#227;o</span><p id="par0265" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; o estudo AFFORD demostrou que os novos ACO s&#227;o custo&#8208;efetivos em compara&#231;&#227;o com as estrat&#233;gias antitromb&#243;ticas convencionais&#44; apesar de o seu elevado custo&#46; Esta ela&#231;&#227;o &#233; verdadeira quer nos mais diversos contextos geogr&#225;ficos e sociais quer adotando diferentes metodologias de an&#225;lise farmacoecon&#243;mica&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Responsabilidades &#233;ticas</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Prote&#231;&#227;o de pessoas e animais</span><p id="par0270" class="elsevierStylePara elsevierViewall">Os autores declaram que para esta investiga&#231;&#227;o n&#227;o se realizaram experi&#234;ncias em seres humanos e&#47;ou animais&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidencialidade dos dados</span><p id="par0275" class="elsevierStylePara elsevierViewall">Os autores declaram que n&#227;o aparecem dados de pacientes neste artigo&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Direito &#224; privacidade e consentimento escrito</span><p id="par0280" class="elsevierStylePara elsevierViewall">Os autores declaram que n&#227;o aparecem dados de pacientes neste artigo&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflito de interesses</span><p id="par0285" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introdu&#231;&#227;o e objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Os novos anticoagulantes orais s&#227;o op&#231;&#245;es emergentes para a preven&#231;&#227;o e tratamento das doen&#231;as tromboemb&#243;licas&#46; S&#227;o cada vez mais usados na pr&#225;tica cl&#237;nica pela facilidade do seu uso e pelos seus benef&#237;cios cl&#237;nicos&#44; mas a sua utiliza&#231;&#227;o mais generalizada carece de demonstra&#231;&#227;o de custo&#8208;efetividade&#46; O objetivo do estudo <span class="elsevierStyleUnderline">A</span> Review of Cost E<span class="elsevierStyleUnderline">FF</span>ectiveness of Novel <span class="elsevierStyleUnderline">OR</span>al Anticoagulant <span class="elsevierStyleUnderline">D</span>rugs &#40;AFFORD&#41; consistiu na realiza&#231;&#227;o de uma revis&#227;o sistem&#225;tica dos estudos de custo&#8208;efetividade dos novos anticoagulantes orais na preven&#231;&#227;o do acidente vascular cerebral &#40;AVC&#41; na fibrilha&#231;&#227;o auricular n&#227;o valvular &#40;FA&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Foi realizada uma revis&#227;o sistem&#225;tica da literatura nas bases de dados Pubmed&#44; Embase&#44; Scopus&#44; Cochrane e Web of Knowledge para identificar todos os estudos de custo&#8208;efetividade dos novos anticoagulantes orais na preven&#231;&#227;o do AVC na FA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A pesquisa selecionou 27 estudos&#44; 18 com dabigatrano&#44; tr&#234;s com apixabano&#44; dois com rivaroxabano e quatro com pelo menos dois destes f&#225;rmacos&#46; Os r&#225;cios custo&#8208;efetividade incremental por anos de vida ajustados para qualidade foram de 30 405<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16 101 euros para o dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg&#44; 17 566<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16 902 euros para o dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&#44; 8102<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3252 euros para o dabigatrano ajustado &#224; idade&#44; 11 897<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3341 euros para o apixabano e 17 960<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 005 euros para o rivaroxabano&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclus&#245;es</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A presente revis&#227;o sistem&#225;tica demonstra que os novos anticoagulantes orais s&#227;o custo&#8208;efetivos para a preven&#231;&#227;o do AVC na FA&#46;</p></span>"
        "secciones" => array:4 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction and Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Novel oral anticoagulants are emerging options for the prevention and treatment of thromboembolic diseases&#46; They are increasingly used in clinical practice due to their simplicity of use and clinical benefits&#44; but an important step is to evaluate their cost&#8208;effectiveness&#46; The aim of the AFFORD study &#40;A Review of Cost EFFectiveness of Novel ORal Anticoagulant Drugs&#41; was to perform a systematic review of cost&#8208;effectiveness studies of novel oral anticoagulants for stroke prevention in non&#8208;valvular atrial fibrillation &#40;AF&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A systematic review of the literature was conducted by searching the PubMed&#44; Embase&#44; Scopus&#44; Cochrane and Web of Knowledge databases to identify all cost&#8208;effectiveness studies of novel oral anticoagulants for stroke prevention in AF&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The search identified 27 studies&#44; 18 with dabigatran&#44; three with apixaban&#44; two with rivaroxaban and four with at least two of these drugs&#46; The incremental cost&#8208;effectiveness ratios were 30 405&#177;16 101 euros per quality&#8208;adjusted life&#8208;year &#40;QALY&#41; for dabigatran 110 mg&#44; 17 566&#177;16 902 euros&#47;QALY for dabigatran 150 mg&#44; 8102&#177;3252 euros&#47;QALY for age&#8208;adjusted dabigatran&#44; 11 897&#177;3341 euros&#47;QALY for apixaban and 17 960&#177;12 005 euros&#47;QALY for rivaroxaban&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The present systematic review demonstrates that novel oral anticoagulants are cost&#8208;effective for stroke prevention in AF&#46;</p></span>"
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          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o dos RCEI por AVAQ&#44; ap&#243;s convers&#227;o em euros&#44; quando apropriado&#44; com o LPFDP de 30 000 euros&#47;AVAQ adotado em Portugal&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pa&#237;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Novo ACO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre&#231;o novo ACO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comparador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pre&#231;o comparador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Perspetiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Modelo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Resultados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LPFDP e an&#225;lise de sensibilidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Freeman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;07<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema de sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; 45 372<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQDabigatrano custo&#8208;efetivo&#58;80&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; 51 229<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano custo&#8208;efetivo&#58;80&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Kansal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano ajustado &#224; idade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;52<span class="elsevierStyleHsp" style=""></span>&#163;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;04<span class="elsevierStyleHsp" style=""></span>&#163;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema de sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; 4831<span class="elsevierStyleHsp" style=""></span>&#163;&#47;AVAQ &#60;<span class="elsevierStyleHsp" style=""></span>80 anosRCEI&#58; 7&#46;090<span class="elsevierStyleHsp" style=""></span>&#163;&#47;AVAQ &#8211;&#8805;<span class="elsevierStyleHsp" style=""></span>80 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 000<span class="elsevierStyleHsp" style=""></span>&#163;&#47;AVAQProbabilidade do dabigatrano ser o mais custo&#8208;efetivo&#60;<span class="elsevierStyleHsp" style=""></span>80 anos&#58; 98&#37;&#62;<span class="elsevierStyleHsp" style=""></span>80 anos&#58; 63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;88<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;49<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema de sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 21 300<span class="elsevierStyleHsp" style=""></span>USDRCEI&#58; 150 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQDabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg n&#227;o &#233; custo&#8208;efetivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;88<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 20 700<span class="elsevierStyleHsp" style=""></span>USDRCEI&#58; 86 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg &#233; custo&#8208;efetivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sorensen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Canad&#225;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano ajustado &#224; idade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;2<span class="elsevierStyleHsp" style=""></span>CAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;6<span class="elsevierStyleHsp" style=""></span>CAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema de sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 2178<span class="elsevierStyleHsp" style=""></span>CADRCEI&#58; 10 440<span class="elsevierStyleHsp" style=""></span>CAD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 000<span class="elsevierStyleHsp" style=""></span>CAD&#47;AVAQDabigatrano custo&#8208;efetivo&#58;82&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;2<span class="elsevierStyleHsp" style=""></span>CAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 4210<span class="elsevierStyleHsp" style=""></span>CADRCEI&#58; 29 994<span class="elsevierStyleHsp" style=""></span>CAD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano custo&#8208;efetivo&#58;42&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;2<span class="elsevierStyleHsp" style=""></span>CAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 1655<span class="elsevierStyleHsp" style=""></span>CAD041<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano custo&#8208;efetivo&#58;81&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Pink et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;52<span class="elsevierStyleHsp" style=""></span>&#163;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11<span class="elsevierStyleHsp" style=""></span>&#163;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Modelo de simula&#231;&#227;o de eventos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; 43 074<span class="elsevierStyleHsp" style=""></span>&#163;&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 000<span class="elsevierStyleHsp" style=""></span>&#163;&#47;AVAQDabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg dominante vs&#46; 110<span class="elsevierStyleHsp" style=""></span>mg&#58; 76&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; 23 082<span class="elsevierStyleHsp" style=""></span>&#163;&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg dominante vs&#46; varfarina&#58; 94&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Gonz&#225;lez&#8208;Juanatey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Espanha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;03<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;05<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema de sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 4851<span class="elsevierStyleHsp" style=""></span>&#8364;RCEI&#58; 17 581<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 000<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQDabigatrano dominante&#58;96&#44;4&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Adcock et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sociedade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; 12 286<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQDabigatrano dominante para custo di&#225;rio &#60;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Langkilde e Overgaard<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dinamarca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano ajustado &#224; idade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;63<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;26<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema de sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 1866<span class="elsevierStyleHsp" style=""></span>&#8364;RCEI &#8211; 6950<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 000<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQDabigatrano &#233; custo&#8208;efetivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ali e Bailey<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg e 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;4<span class="elsevierStyleHsp" style=""></span>&#163;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;08<span class="elsevierStyleHsp" style=""></span>&#163;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Estudo observacional prospetivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo dos ACO para prevenir um AVC&#47;ano&#58; varfarina 6219<span class="elsevierStyleHsp" style=""></span>&#163;&#59; dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg 28 086&#44;5<span class="elsevierStyleHsp" style=""></span>&#163; e dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg 25 181<span class="elsevierStyleHsp" style=""></span>&#163;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">You et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pagador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 16 909<span class="elsevierStyleHsp" style=""></span>USDRCEI&#58; dominado pelo dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQDabigatrano custo&#8208;efetivo&#58;1&#44;6&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 7057<span class="elsevierStyleHsp" style=""></span>USDRCEI&#58; 13 810<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano custo&#8208;efetivo&#58;50&#44;6&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Wouters et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#233;lgica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;68<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;32<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema de sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 879<span class="elsevierStyleHsp" style=""></span>&#8364;RCEI&#58; 2807<span class="elsevierStyleHsp" style=""></span>&#8364;&#47; AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 000<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQDabigatrano custo&#8208;efetivo&#58;99&#44;85&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Bergh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#193;frica do Sul&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano ajustado &#224; idade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;66<span class="elsevierStyleHsp" style=""></span>ZAR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;2<span class="elsevierStyleHsp" style=""></span>ZAR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pagador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 19 037<span class="elsevierStyleHsp" style=""></span>ZARRCEI&#58; 93 290<span class="elsevierStyleHsp" style=""></span>ZAR&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Davidson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Su&#233;cia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano ajustado &#224; idade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;82<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;12<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sociedade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 2212<span class="elsevierStyleHsp" style=""></span>&#8364;RCEI&#58; 7742<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQDabigatrano &#233; custo&#8208;efetivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Pletscher et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Su&#237;&#231;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>CFH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fenprocoumon 2&#44;25<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;21<span class="elsevierStyleHsp" style=""></span>CFH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pagador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; 25 108<span class="elsevierStyleHsp" style=""></span>CFH&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>CFH&#47;AVAQProbabilidade do dabigatrano ser o mais custo&#8208;efetivo&#58; 84&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>CFH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; 9702<span class="elsevierStyleHsp" style=""></span>CFH&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probabilidade do dabigatrano ser o mais custo&#8208;efetivo&#58; 95&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano ajustado &#224; idade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>CFH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; 10 215<span class="elsevierStyleHsp" style=""></span>CFH&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probabilidade do dabigatrano ser o mais custo&#8208;efetivo&#58; 97&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Andrikopoulos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gr&#233;cia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;72<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;04<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pagador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 4996<span class="elsevierStyleHsp" style=""></span>&#8364;RCEI&#58;16 653<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;72<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 4218<span class="elsevierStyleHsp" style=""></span>&#8364;RCEI&#58; 11 400<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQDabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg &#233; custo&#8208;efetivo em 87&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Miguel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Portugal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano ajustado &#224; idade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;53<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;08<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sociedade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 2978<span class="elsevierStyleHsp" style=""></span>&#8364;RCEI&#58; 8409<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 000<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQDabigatrano &#233; custo&#8208;efetivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Chang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;3&#8208;2&#44;5<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;3<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pagador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; 68 333<span class="elsevierStyleHsp" style=""></span>USD&#47;evento prevenido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;7<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;03&#8208;0&#44;04<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RCEI&#58; dabigatrano dominante &#40;&#8211;34 350<span class="elsevierStyleHsp" style=""></span>USD&#47;evento prevenido&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Kamel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;75<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;04<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 9000<span class="elsevierStyleHsp" style=""></span>USDRCEI&#58; 25 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQDabigatrano custo&#8208;efetivo&#58;87&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rivaroxabano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;8<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;06<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pagador&#47; sistema de sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 5912<span class="elsevierStyleHsp" style=""></span>USDRCEI &#8211; 27 498<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQRivaroxabano custo&#8208;efetivo&#58;80&#44;1&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Kleintjens et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#233;lgica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rivaroxabano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;70<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;31<span class="elsevierStyleHsp" style=""></span>&#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pagador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 828<span class="elsevierStyleHsp" style=""></span>&#8364;RCEI&#58; 8809<span class="elsevierStyleHsp" style=""></span>&#8364;&#47; AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 000<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAQRivaroxabano custo&#8208;efetivo&#58;87&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apixabano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;8<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspirina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;02<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema de sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 9151<span class="elsevierStyleHsp" style=""></span>USDRCEI &#8211; 16 205<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQApixabano custo&#8208;efetivo&#58;87&#44;5&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apixabano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;87<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;2<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema de sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; &#8211;8934<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQApixabano custo&#8208;efetivo&#58;80&#44;1&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Kamel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apixabano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sociedade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 3200<span class="elsevierStyleHsp" style=""></span>USDRCEI&#58; 11 400<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQApixabano custo&#8208;efetivo&#58;62&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Coyle et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Canad&#225;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 110<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pagador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov &#43; meta&#8208;an&#225;lise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo Incremental&#58; 4184<span class="elsevierStyleHsp" style=""></span>CADRCEI&#58; 66 354<span class="elsevierStyleHsp" style=""></span>CAD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>CAD&#47;AVAQDabigatrano custo&#8208;efetivo&#58;1&#44;6&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 2866<span class="elsevierStyleHsp" style=""></span>CADRCEI&#58; 20 797<span class="elsevierStyleHsp" style=""></span>CAD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano custo&#8208;efetivo&#58;50&#44;8&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rivaroxabano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 3396<span class="elsevierStyleHsp" style=""></span>CADRCEI&#58; 55 757<span class="elsevierStyleHsp" style=""></span>CAD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rivaroxabano custo&#8208;efetivo&#58;2&#44;1&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apixabano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 3346<span class="elsevierStyleHsp" style=""></span>CADRCEI&#58; 24&#46;312<span class="elsevierStyleHsp" style=""></span>CAD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apixabano custo&#8208;efetivo&#58;44&#44;1&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Harrington et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;3<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;35<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sociedade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 4906<span class="elsevierStyleHsp" style=""></span>USDRCEI&#58; 3190<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 000<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQDabigatrano custo&#8208;efetivo&#58;40&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rivaroxabano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;29<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 925<span class="elsevierStyleHsp" style=""></span>USDRCEI&#58; 11 150<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rivaroxabano custo&#8208;efetivo&#58;14&#44;9&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apixabano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;34<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 7513<span class="elsevierStyleHsp" style=""></span>USDRCEI&#58; 15 026<span class="elsevierStyleHsp" style=""></span>USD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apixabano custo&#8208;efetivo&#58;45&#44;1&#37; das simula&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Deitelzweig et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano 150<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pagador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; &#8211;179<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rivaroxabano 10<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; &#8211;89<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Apixabano 5<span class="elsevierStyleHsp" style=""></span>mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; &#8211;485<span class="elsevierStyleHsp" style=""></span>USD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Kansal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Canad&#225;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dabigatrano ajustado &#224; idade<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Varfarina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pagador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Markov&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Custo incremental&#58; 1579<span class="elsevierStyleHsp" style=""></span>CAD&#47;doenteRCEI&#58; 6889<span class="elsevierStyleHsp" style=""></span>CAD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 000<span class="elsevierStyleHsp" style=""></span>CAD&#47;AVAQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rivaroxabano&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Principles of pharmacoeconomics and their impact on strategic imperatives of pharmaceutical research and development"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                    0 => array:2 [
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                        "fecha" => "2010"
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                        "paginaFinal" => "1373"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20132213"
                            "web" => "Medline"
                          ]
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                          ]
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              "identificador" => "bib0035"
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                      "titulo" => "Dabigatran versus warfarin in patients with atrial fibrillation"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19717844"
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                          ]
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                    ]
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                ]
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              "identificador" => "bib0040"
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                      "titulo" => "Randomized Evaluation of Long&#8208;Term Anticoagulation Therapy Investigators&#46; Newly identified events in the RE&#8208;LY trial &#91;letter&#93;"
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                        0 => array:2 [
                          "etal" => true
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                            2 => "S&#46; Yusuf"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2010"
                        "volumen" => "363"
                        "paginaInicial" => "1875"
                        "paginaFinal" => "1876"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21047252"
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                          ]
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                    ]
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                ]
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              "identificador" => "bib0045"
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                0 => array:2 [
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                      "titulo" => "Rivaroxaban versus warfarin in nonvalvular atrial fibrillation"
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                            2 => "J&#46; Garg"
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                      ]
                    ]
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                  "host" => array:1 [
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                      "doi" => "10.1056/NEJMoa1009638"
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                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2011"
                        "volumen" => "365"
                        "paginaInicial" => "883"
                        "paginaFinal" => "891"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21830957"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0050"
              "etiqueta" => "10"
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                      "titulo" => "Apixaban in patients with atrial fibrillation"
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                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1107039"
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                        "fecha" => "2011"
                        "volumen" => "365"
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                        "paginaFinal" => "992"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21870978"
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                          ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
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                    0 => array:2 [
                      "titulo" => "Edoxaban versus warfarin in patients with atrial fibrillation"
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                      "doi" => "10.1056/NEJMoa1310907"
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                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "369"
                        "paginaInicial" => "2093"
                        "paginaFinal" => "2104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24251359"
                            "web" => "Medline"
                          ]
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                  ]
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            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and validation of a grading system for the quality of cost&#8208;effectiveness studies"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;F&#46; Chiou"
                            1 => "J&#46;W&#46; Hay"
                            2 => "J&#46;F&#46; Wallace"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.MLR.0000039824.73620.E5"
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                        "tituloSerie" => "Med Care&#46;"
                        "fecha" => "2003"
                        "volumen" => "41"
                        "paginaInicial" => "32"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12544542"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost&#8208;Effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Freeman"
                            1 => "R&#46; Zhu"
                            2 => "D&#46; Owens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/0003-4819-154-1-201101040-00289"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2011"
                        "volumen" => "154"
                        "paginaInicial" => "1"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21041570"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Cost&#8208;effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation"
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                          "etal" => true
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                            2 => "R&#46; Gani"
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                        ]
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22422743"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
            ]
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              "identificador" => "bib0080"
              "etiqueta" => "16"
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                      "titulo" => "Cost&#8208;effectiveness of dabigatran for stroke prophylaxis in atrial fibrillation"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Shah"
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                        "fecha" => "2011"
                        "volumen" => "123"
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                        "paginaFinal" => "2570"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21606397"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0085"
              "etiqueta" => "17"
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                0 => array:2 [
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                      "titulo" => "Cost&#8208;effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation&#58; A Canadian payer perspective"
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                        0 => array:2 [
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                  "host" => array:1 [
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                        "volumen" => "105"
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                        "paginaFinal" => "919"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21431243"
                            "web" => "Medline"
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              ]
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              "etiqueta" => "18"
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                      "titulo" => "Dabigatran etexilate versus warfarin in management of non&#8208;valvular atrial fibrillation in UK context&#58; quantitative benefit&#8208;harm and economic analyses"
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                  "host" => array:1 [
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                        "tituloSerie" => "BMJ&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An&#225;lisis coste&#8208;efectividad de dabigatr&#225;n para la prevenci&#243;n de ictus y embolia sist&#233;mica en &#64257;brilaci&#243;n auricular no valvular en Espa&#241;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Gonz&#225;lez-Juanatey"
                            1 => "J&#46; Ivarez-Sabin"
                            2 => "J&#46; Lobos"
                          ]
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                      ]
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                    0 => array:2 [
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                        "tituloSerie" => "Rev Esp Cardiol&#46;"
                        "fecha" => "2012"
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                        "paginaInicial" => "901"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22958943"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0100"
              "etiqueta" => "20"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Is dabigatran cost effective compared with warfarin for stroke prevention in atrial fibrillation&#63; A critically appraised topic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Adcock"
                            1 => "J&#46; Lee-Iannoti"
                            2 => "M&#46; Aguillar"
                          ]
                        ]
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                      "Revista" => array:6 [
                        "tituloSerie" => "Neurologist"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "102"
                        "paginaFinal" => "107"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22367842"
                            "web" => "Medline"
                          ]
                        ]
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                ]
              ]
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              "identificador" => "bib0105"
              "etiqueta" => "21"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of dabigatran etexilate for stroke prevention in non&#8208;valvular atrial fibrillation&#46; Applying RE&#8208;LY to clinical practice in Denmark"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Langkilde"
                            1 => "M&#46; Overgaard"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3111/13696998.2012.673525"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Econ"
                        "fecha" => "2012"
                        "volumen" => "15"
                        "paginaInicial" => "695"
                        "paginaFinal" => "703"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22397590"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abdelhafiz&#46; Stroke prophylaxis with warfarin or dabigatran for patients with non&#8208;valvular atrial fibrillation &#8208; cost analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Ali"
                            1 => "C&#46; Bailey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Age Ageing"
                        "fecha" => "2012"
                        "volumen" => "0"
                        "paginaInicial" => "1"
                        "paginaFinal" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of dabigatran versus genotype&#8208;guided management of warfarin therapy for stroke prevention in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; You"
                            1 => "K&#46; Tsui"
                            2 => "R&#46; Wong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "PlosOne"
                        "fecha" => "2012"
                        "paginaInicial" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of dabigatran etexilate in the prevention of stroke and systemic embolism in patients with atrial fibrillation in Belgium"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Wouters"
                            1 => "V&#46; Thij"
                            2 => "L&#46; Annemans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3111/13696998.2013.766200"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Econ"
                        "fecha" => "2013"
                        "volumen" => "16"
                        "paginaInicial" => "407"
                        "paginaFinal" => "414"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23320796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Economic appraisal of dabigatran as first&#8208;line therapy for stroke prevention in atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Bergh"
                            1 => "C&#46; Marais"
                            2 => "H&#46; Miller-Janson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "S Afr Med J"
                        "fecha" => "2013"
                        "volumen" => "103"
                        "paginaInicial" => "241"
                        "paginaFinal" => "245"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23547700"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of dabigatran compared with warfarin for patients with atrial fibrillation in Sweden"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Davidson"
                            1 => "M&#46; Husberg"
                            2 => "M&#46; Janzon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs157"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "177"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22733833"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Pletscher M&#44; Plessow R&#44; Wieser S&#46; Cost&#8208;effectiveness of dabigatran for stroke prevention in atrial fibrillation in Switzerland&#46; Swiss Medical Weekly&#46; 2313&#59; 143&#58;w13732&#46;"
                ]
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              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Economic evaluation of dabigatran etexilate in the management of atrial fibrillation in Greece"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:3 [
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                            2 => "N&#46; Maniadakis"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hellenic J Cardiol"
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                        "paginaInicial" => "289"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23912921"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
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                ]
              ]
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            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Avalia&#231;&#227;o econ&#243;mica do dabigatrano na preven&#231;&#227;o de acidentes vasculares cerebrais isqu&#233;micos em doentes com fibrilha&#231;&#227;o auricular n&#227;o valvular"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Miguel"
                            1 => "E&#46; Rocha"
                            2 => "J&#46; Ferreira"
                          ]
                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2013.01.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "557"
                        "paginaFinal" => "565"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23890991"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:3 [
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                            1 => "J&#46; Ho"
                            2 => "B&#46; Yan"
                          ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/clc.22112"
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                        "tituloSerie" => "Clin Cardiol"
                        "fecha" => "2013"
                        "volumen" => "36"
                        "paginaInicial" => "280"
                        "paginaFinal" => "285"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23494609"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
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              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of dabigatran compared with warfarin for stroke prevention in patients with atrial fibrillation and prior stroke or transient ischemic attack"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Kamel"
                            1 => "S&#46; Johnston"
                            2 => "D&#46; Easton"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2012"
                        "volumen" => "43"
                        "paginaInicial" => "881"
                        "paginaFinal" => "883"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22308255"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of rivaroxaban compared to warfarin for stroke prevention in atrial fibrillation"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:3 [
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                            2 => "D&#46; Pham"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2012.05.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2012"
                        "volumen" => "110"
                        "paginaInicial" => "845"
                        "paginaFinal" => "851"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22651881"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "X&#46; Li"
                            2 => "S&#46; Simoens"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Pharmacoeconomics"
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                        "paginaInicial" => "909"
                        "paginaFinal" => "918"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24030788"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
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                ]
              ]
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            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of apixaban compared with aspirin for stroke prevention in atrial fibrillation among patients unsuitable for warfarin"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "J&#46; Meng"
                          ]
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Qual Outcomes"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "472"
                        "paginaFinal" => "479"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22740012"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
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            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of apixaban compared with aspirin for stroke prevention in atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "R&#46; Mullin"
                            2 => "J&#46; Blazawski"
                          ]
                        ]
                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "PlosOne"
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                        "paginaInicial" => "1"
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                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of apixaban vs warfarin for secondary stroke prevention in atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "D&#46; Easton"
                            2 => "S&#46; Johnston"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "2012"
                        "volumen" => "79"
                        "paginaInicial" => "1428"
                        "paginaFinal" => "1434"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22993279"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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                  ]
                ]
              ]
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            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of new oral anticoagulants compared with warfarin in preventing stroke and other cardiovascular events in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Coyle"
                            1 => "K&#46; Coyle"
                            2 => "C&#46; Cameron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jval.2013.01.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Value Health"
                        "fecha" => "2013"
                        "volumen" => "16"
                        "paginaInicial" => "498"
                        "paginaFinal" => "506"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23796283"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost&#8208;effectiveness of apixaban&#44; dabigatran&#44; rivaroxaban and warfarin for stroke prevention in atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "E&#46; Armstrong"
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                          ]
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
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                        "volumen" => "44"
                        "paginaInicial" => "1676"
                        "paginaFinal" => "1681"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23549134"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
              ]
            ]
            38 => array:3 [
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