Xie Lin, Vo Lien, Keshishian Allison, Price Kwanza, Singh Prianka, Mardekian Jack, Bruno Amanda, Baser Onur, Kim Jully, Tan Wilson, Trocio Jeffrey
a STATinMED Research , Ann Arbor , MI , USA ;
b Bristol-Myers Squibb , New York , NY , USA ;
J Med Econ. 2016 Aug;19(8):769-76. doi: 10.3111/13696998.2016.1171774. Epub 2016 Apr 24.
To quantify and compare hospital length of stay (LOS) and costs between hospitalized non-valvular atrial fibrillation (NVAF) patients treated with either apixaban or warfarin via a large claims database.
Adult patients hospitalized with AF were selected from the Premier Perspective Claims Database (01JAN2013-31MARCH2014). Patients with evidence of valvular heart disease, valve replacement procedures, or pregnancy during the index hospitalization were excluded. Patients treated with apixaban or warfarin during hospitalization were identified. Propensity score matching (PSM) was performed to control for baseline imbalances between patients treated with apixaban or warfarin. Primary outcomes were hospital LOS (days), post-medication administration LOS, and index hospitalization costs, and were compared using paired t-tests in the matched sample.
Before PSM, 2894 apixaban and 124,174 warfarin patients were identified. Patients treated with warfarin were older and sicker compared to those treated with apixaban. After applying PSM, a total of 2886 patients were included in each cohort, and baseline characteristics were balanced. The mean (standard deviation [SD] and median) hospital LOS was significantly (p = 0.002) shorter for patients treated with apixaban for 5.1 days (5.7 and 3) compared to warfarin for 5.5 days (4.8 and 4). The trend appeared consistent in the hospital LOS from point of apixaban or warfarin administration to discharge (4.5 vs 4.7 days, p = 0.051). Patients administered apixaban incurred significantly lower hospitalization costs compared to those administered warfarin ($11,262 vs $12,883; p < 0.001).
Among NVAF patients, apixaban treatment was associated with significantly shorter hospital LOS and lower costs when compared to warfarin treatment.
通过一个大型理赔数据库，对接受阿哌沙班或华法林治疗的非瓣膜性心房颤动（NVAF）住院患者的住院时间（LOS）和费用进行量化和比较。
从Premier Perspective Claims数据库（2013年1月1日 - 2014年3月31日）中选取因房颤住院的成年患者。排除在本次住院期间有瓣膜性心脏病、瓣膜置换手术或妊娠证据的患者。确定住院期间接受阿哌沙班或华法林治疗的患者。进行倾向评分匹配（PSM）以控制接受阿哌沙班或华法林治疗患者之间的基线不平衡。主要结局为住院LOS（天数）、用药后LOS和本次住院费用，并在匹配样本中使用配对t检验进行比较。
在PSM之前，确定了2894例接受阿哌沙班治疗的患者和124174例接受华法林治疗的患者。与接受阿哌沙班治疗的患者相比，接受华法林治疗的患者年龄更大且病情更重。应用PSM后，每个队列共纳入2886例患者，基线特征得到平衡。接受阿哌沙班治疗的患者平均（标准差[SD]和中位数）住院LOS为5.1天（5.7和3），显著短于接受华法林治疗患者的5.5天（4.8和4）（p = 0.002）。从阿哌沙班或华法林给药到出院的住院LOS趋势似乎一致（4.5天对4.7天，p = 0.051）。与接受华法林治疗的患者相比，接受阿哌沙班治疗的患者住院费用显著更低（11262美元对12883美元；p < 0.001）。
在NVAF患者中，与华法林治疗相比，阿哌沙班治疗与显著更短的住院LOS和更低的费用相关。
