J Manag Care Spec Pharm：阿哌沙班vs华法林对老年NVAF患者HCRU和成本的影响

2018-01-20 梁舒瑶环球医学网

发表在《J Manag Care Spec Pharm》的一项研究考察了阿哌沙班vs华法林对老年非瓣膜性房颤（NVAF）患者的健康医疗资源使用（HCRU）和成本的影响

发表在《J Manag Care Spec Pharm》的一项研究考察了阿哌沙班vs华法林对老年非瓣膜性房颤（NVAF）患者的健康医疗资源使用（HCRU）和成本的影响

背景：ARISTOTLE这项临床试验显示，阿哌沙班在降低NVAF患者卒中和出血风险方面优于华法林。需要进一步研究，在真实世界中考察阿哌沙班vs华法林对HCRU和相关成本的影响，尤其是对于卒中或出血风险较高的老年患者而言。

目的：比较在美国接受阿哌沙班与华法林治疗的老年NVAF患者的HCRU和成本。

方法：从Humana研究数据库中确定2013年1月1日至2015年9月30日开始使用阿哌沙班或华法林且参加Medicare的老年患者（年龄≥65岁）。在基线期间或起始用药时，在药物起始（基线期）和确诊为房颤前，患者需要连续12个月参加医保。根据起始用药，NVAF患者被分为不同队列。进行倾向评分匹配（PSM），以控制研究队列的人口统计学和临床特征差异。在编入索引后，对患者随访，随访期可变。评价PSM前后随访期中的全因和特定疾病HCRU和成本，并按照每例患者每年进行报告。

结果：在总（未匹配）人群中，8250例患者（平均年龄：78.0岁）起始阿哌沙班，14051例患者（平均年龄：78.2岁）起始华法林。与起始华法林的NVAF患者相比，起始阿哌沙班的NVAF患者平均Charlson合并症指数（CCI）评分（3.0 vs 3.4，P＜0.001）；卒中风险评分，包括CHADS2（2.7 vs 2.9，P＜0.001）和CHA2DS2-VASc（4.6 vs 4.7，P＜0.001）；以及出血风险评分，包括HAS-BLED（3.1 vs 3.2，P＜0.001）更低。此外，与华法林相比，基线期使用阿哌沙班的患者的总年度全因死亡健康医疗成本更低（$17077 vs $20236，P＜0.001）。PSM后，对14214例患者进行匹配，每个队列7107例患者。匹配队列之间的平均年龄、CCI评分以及卒中和出血风险相似，基线期间的总全因健康医疗成本也相似。匹配队列的随访期间，与华法林相比，阿哌沙班治疗与较高的年度药物成本（$5159 vs $2867，P＜0.001）、较低的年度住院（$8327 vs $14296，P＜0.001）、门诊（$9655 vs $11469，P＜0.001）和总全因健康医疗成本（$23141 vs $28633，P＜0.001）相关，这反映出阿哌沙班治疗的患者中住院、门诊和全因HCRU较低。此外，与华法林相比，阿哌沙班治疗的患者中出血相关（$2101 vs $3963，P＜0.001）和卒中相关（$652 vs $1178，P=0.001）年度医疗成较低。

结论：控制患者特征的差异后，在真实世界中，在老年NVAF患者中，与华法林使用相比，阿哌沙班与较低的HCRU和较低的总全因健康医疗成本及较低的出血和卒中相关医疗服务成本但更大的药物成本相关。

原始出处：

Deitelzweig S, Luo X, Gupta K, et al.Effect of Apixaban Versus Warfarin Use on Health Care Resource Utilization and Costs Among Elderly Patients with Nonvalvular Atrial Fibrillation.J Manag Care Spec Pharm. 2017 Nov;23(11):1191-1201. doi: 10.18553/jmcp.2017.17060. Epub 2017 Aug 11.

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2018-05-23 zhmscau

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2018-02-21 bnurmamat

#老年NVAF患者#

21 0
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2018-01-30 AspirantSuo

#ANA#

29 0
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2018-06-05 jj000001

#Pharm#

19 0
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2018-11-10 feather89

#PE#

24 0
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2018-01-21 红木中餐

henhao

71 0
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2018-01-20 1e0e5697m83(暂无匿称)

henhao

65 0
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2018-01-20 九九消寒

优质资源.共同学习

59 0

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