Deitelzweig Steve, Evans Michael, Hillson Eric, Trocio Jeffrey, Bruno Amanda, Tan Wilson, Lingohr-Smith Melissa, Singh Prianka, Lin Jay
a a Ochsner Health System, Department of Hospital Medicine , New Orleans , LA , USA.
b b Geisinger Health System, Enterprise Pharmacy , Danville , PA , USA.
Curr Med Res Opin. 2016;32(1):87-94. doi: 10.1185/03007995.2015.1103217. Epub 2015 Nov 2.
Warfarin is efficacious for reducing stroke risk among patients with nonvalvular atrial fibrillation (NVAF). However, the efficacy and safety of warfarin are influenced by its time in therapeutic range (TTR).
To assess differences in healthcare resource utilization and costs among NVAF patients with low (<60%) and high (≥60%) warfarin TTRs in an integrated delivery network (IDN) setting.
Patients with NVAF were identified from an electronic medical record database. Patients were required to have ≥6 international normalized prothrombin time ratio (INR) tests. NVAF patients were grouped into two cohorts: those with warfarin TTR <60% (low TTR) and those with warfarin TTR ≥60% (high TTR). Healthcare resource utilization and costs were evaluated during a 12 month follow-up period. Multivariable regressions were used to assess the impact of different warfarin TTRs on healthcare costs.
Among the study population, greater than half (54%, n = 1595) had a low TTR, and 46% (n = 1356) had a high TTR. Total all-cause healthcare resource utilization was higher among patients in the low TTR cohort vs. the high TTR cohort (number of encounters: 70.2 vs. 56.1, p < 0.001). After adjusting for patient characteristics, total all-cause healthcare costs and stroke-related healthcare costs were $2398 (p < 0.001) and $687 (p = 0.02) higher, respectively, for patients in the low TTR cohort vs. the high TTR cohort.
In this retrospective study, we were only able to evaluate the association and not the causality between healthcare resource utilization and costs with the different warfarin TTRs.
Many warfarin-treated NVAF patients have a low warfarin TTR. NVAF patients with low vs. patients with high warfarin TTR used healthcare resources to a greater extent, which was reflected in higher healthcare costs.
华法林对于降低非瓣膜性心房颤动（NVAF）患者的中风风险有效。然而，华法林的疗效和安全性受其处于治疗范围的时间（TTR）影响。
评估在综合医疗服务网络（IDN）环境下，华法林TTR低（<60%）和高（≥60%）的NVAF患者在医疗资源利用和成本方面的差异。
从电子病历数据库中识别出NVAF患者。患者需进行≥6次国际标准化凝血酶原时间比值（INR）检测。NVAF患者被分为两个队列：华法林TTR<60%（低TTR）的患者和华法林TTR≥60%（高TTR）的患者。在12个月的随访期内评估医疗资源利用和成本。采用多变量回归分析评估不同华法林TTR对医疗成本的影响。
在研究人群中，超过一半（54%，n = 1595）的患者TTR较低，46%（n = 1356）的患者TTR较高。低TTR队列患者的全因医疗资源总利用量高于高TTR队列（就诊次数：70.2次对56.1次，p < 0.001）。在调整患者特征后，低TTR队列患者的全因医疗总成本和中风相关医疗成本分别比高TTR队列患者高2398美元（p < 0.001）和687美元（p = 0.02）。
在这项回顾性研究中，我们只能评估医疗资源利用和成本与不同华法林TTR之间的关联，而非因果关系。
许多接受华法林治疗的NVAF患者华法林TTR较低。与华法林TTR高的患者相比，TTR低的NVAF患者更多地使用了医疗资源，这体现在更高的医疗成本上。
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