IMS Health, Plymouth Meeting, PA, USA.
Curr Med Res Opin. 2009 Dec;25(12):2853-64. doi: 10.1185/03007990903196422.
To determine the direct healthcare costs associated with the onset of chronic nonvalvular atrial fibrillation (CNVAF), warfarin utilization and the occurrence of cerebrovascular events in a commercially-insured population.
This retrospective, observational cohort study utilized medical and pharmacy claims from a large, geographically diverse managed-care organization (N = 18.5 million) to identify continuously benefit-eligible CNVAF patients > or =45 years of age without prior valvular disease or warfarin use between January 1, 2001 and June 1, 2002. All patients were followed at least 6 months, until plan termination or the end of study follow-up. Stroke risk was assessed using the CHADS(2) (stroke-risk) index; warfarin use was defined as having filled at least one pharmacy claim. Inpatient and outpatient cost benchmarks were utilized to estimate total direct healthcare costs (pre- and post-AF index claim). For patients with transient ischemic attacks (TIA), ischemic stroke (IS) and major bleed (MB) total direct healthcare costs were also assessed. The limitations of this study included a descriptive retrospective study design without a comparison group or adjustment for baseline disease severity and drug exposure, as well as, the reliance upon administrative claims data and use of a standardized reference costing methodology.
The pre- and post-AF onset total direct healthcare costs (pmpm) for 3891 incidence CNVAF patients were $412 and $1235, respectively, a 200% increase. Of the 448 (12%) patients with a cerebrovascular event, pmpm costs post-AF ranged from $2235 to $3135 correlating with CHADS(2) stroke-risk status and exposure to warfarin. Total cohort pmpm costs pre and post event increased 24% from $3446.91 to $4262.12. Approximately 20% of all events occurred <2 days and 46% within 1 month after the index AF claim. Any warfarin exposure, regardless of CHADS(2) risk had an 18% to 29 % decrease in pmpm costs.
Post-AF total direct healthcare costs were 3 times greater than pre-AF costs. For those with a TIA, IS or MB, post-AF total direct healthcare costs increased 4.5 times from pre-AF costs; overall post-event costs in this cohort increased approximately 25% over pre-event costs. Nearly half of the events occurred within 1 month of a claim associated with an AF diagnosis. Warfarin exposure appeared to be associated with lower pmpm costs in this population.
确定与慢性非瓣膜性心房颤动（CNVAF）发作、华法林使用和脑血管事件相关的直接医疗成本，在商业保险人群中。
本回顾性观察队列研究利用大型地理多样化管理式医疗组织（N=1850 万）的医疗和药房理赔数据，确定无瓣膜疾病或华法林使用史的≥45 岁持续受益的 CNVAF 患者，其在 2001 年 1 月 1 日至 2002 年 6 月 1 日期间符合 CNVAF 标准。所有患者的随访时间至少为 6 个月，直至计划终止或研究随访结束。使用 CHADS（2）（中风风险）指数评估中风风险；华法林使用定义为至少有一个药房理赔。利用住院和门诊成本基准来估计 AF 指数理赔前和理赔后的总直接医疗成本（预 AF 和后 AF）。对于短暂性脑缺血发作（TIA）、缺血性中风（IS）和大出血（MB）的患者，也评估了总直接医疗成本。本研究的局限性包括没有对照组的描述性回顾性研究设计，以及缺乏对基线疾病严重程度和药物暴露的调整，以及依赖于行政索赔数据和使用标准化参考成本方法。
3891 例新发 CNVAF 患者的 AF 发作前和发作后总直接医疗成本（ppm）分别为$412 和$1235，增长了 200%。在 448 例（12%）发生脑血管事件的患者中，AF 后 CHADS（2）中风风险状况和华法林暴露的 ppm 成本范围为$2235 至$3135。总队列的事件前和事件后 ppm 成本分别从$3446.91 增加到$4262.12，增长了 24%。大约 20%的事件发生在 AF 指数理赔后 2 天内，46%发生在 1 个月内。无论 CHADS（2）风险如何，任何华法林暴露都使 ppm 成本降低了 18%至 29%。
AF 后总直接医疗成本是 AF 前的 3 倍。对于 TIA、IS 或 MB 患者，AF 后总直接医疗成本比 AF 前增加了 4.5 倍；在这一队列中，总体事件后成本比事件前成本增加了约 25%。近一半的事件发生在与 AF 诊断相关的理赔后 1 个月内。在这一人群中，华法林暴露似乎与较低的 ppm 成本相关。
