Ochsner Clinic Foundation, New Orleans, LA, USA.
J Med Econ. 2013 Sep;16(9):1163-8. doi: 10.3111/13696998.2013.826664. Epub 2013 Aug 8.
Based on clinical trials the oral anticoagulants (OACs) apixaban, dabigatran, and rivaroxaban are efficacious for reducing stroke risk for non-valvular atrial fibrillation (NVAF) patients. Based on the clinical trials, this study evaluated the medical costs for clinical events among NVAF patients ≥75 and <75 years of age treated with individual OACs vs warfarin.
Rates for primary and secondary efficacy and safety outcomes (i.e., clinical events) among NVAF patients receiving warfarin or each of the OACs were determined for NVAF populations aged ≥75 years and <75 years of age from the OAC vs warfarin trials. One-year incremental costs among patients with clinical events were obtained from published literature and inflation adjusted to 2010 costs. Medical costs, excluding medication costs, for clinical events associated with each OAC and warfarin were then estimated and compared.
Among NVAF patients aged ≥75, compared to warfarin, use of either apixaban or rivaroxaban was associated with a reduction in medical costs per patient year (apixaban = -$825, rivaroxaban =-$23), while dabigatran use was associated with increased medical costs of $180 per patient year. Among NVAF patients <75 years of age medical costs per patient year were estimated to be reduced -$254, -$367, and -$88, for apixaban, dabigatran, and rivaroxaban, respectively, in comparison to warfarin.
This economic analysis was based on clinical trial data and, therefore, the direct application of the results to routine clinical practice will require further assessment.
Difference in medical costs between OAC and warfarin treated NVAF patients vary by age group and individual OACs. Although reductions in medical costs for NVAF patients aged ≥75 and <75 were observed for those using either apixaban or rivaroxaban vs warfarin, the reductions were greater per patient year for both the older and younger NVAF populations using apixaban.
基于临床试验，口服抗凝剂（OAC）阿哌沙班、达比加群和利伐沙班在降低非瓣膜性心房颤动（NVAF）患者中风风险方面是有效的。基于临床试验，本研究评估了 75 岁及以上和<75 岁 NVAF 患者接受 OAC 与华法林治疗时，与临床事件相关的医疗成本。
从 OAC 与华法林试验中确定了 75 岁及以上和<75 岁 NVAF 患者接受华法林或 OAC 中每一种治疗时主要和次要疗效及安全性结局（即临床事件）的发生率。从已发表的文献中获得了临床事件患者的一年增量成本，并按 2010 年的通胀率进行了调整。然后估计并比较了与每个 OAC 和华法林相关的临床事件的医疗成本，不包括药物成本。
在 75 岁及以上的 NVAF 患者中，与华法林相比，使用阿哌沙班或利伐沙班与每位患者每年的医疗成本降低相关（阿哌沙班=-$825，利伐沙班=-$23），而使用达比加群与每位患者每年的医疗成本增加相关，增加了$180。在<75 岁的 NVAF 患者中，与华法林相比，阿哌沙班、达比加群和利伐沙班的每位患者每年的医疗成本估计分别降低了-$254、-$367 和-$88。
本经济分析基于临床试验数据，因此，要将研究结果直接应用于常规临床实践，还需要进一步评估。
OAC 和华法林治疗的 NVAF 患者的医疗成本差异因年龄组和 OAC 个体而异。虽然对于 75 岁及以上和<75 岁的 NVAF 患者，与华法林相比，使用阿哌沙班或利伐沙班的患者的医疗成本有所降低，但对于年龄较大和较小的 NVAF 患者，阿哌沙班的降低幅度更大。
