Margolis Jay M, Deitelzweig Steven, Kline Jeffrey, Tran Oth, Smith David M, Crivera Concetta, Bookhart Brahim, Schein Jeff
Truven Health Analytics, Bala Cynwyd, Pennsylvania.
Ochsner Health System and The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana.
Clin Ther. 2016 Nov;38(11):2496-2503. doi: 10.1016/j.clinthera.2016.09.007. Epub 2016 Oct 15.
Using real-world data, this study compares inpatient length of stay (LOS) and costs for patients with a primary diagnosis of pulmonary embolism (PE) initiating treatment with oral anticoagulation with rivaroxaban versus warfarin.
Hospitalizations from MarketScan's Hospital Drug Database were selected from November 1, 2012, through December 31, 2013, for adults with a primary diagnosis of PE initiating treatment with rivaroxaban or warfarin. Warfarin patients were matched 1:1 to rivaroxaban patients using exact and propensity score matching. Hospital LOS, treatment patterns, and hospitalization costs were evaluated.
Matched cohorts included 751 rivaroxaban-treated patients and 751 warfarin-treated patients. Adjusted mean LOS was 3.77 days for rivaroxaban patients (95% CI, 3.66-3.87 days) and 5.48 days for warfarin patients (95% CI, 5.33-5.63 days; P < .001). Mean (SD) LOS was shorter for patients taking rivaroxaban whether admission was for provoked PE (rivaroxaban: 5.2 [5.1] days; warfarin: 7.0 [6.5] days; P < .001) or unprovoked PE (rivaroxaban: 3.4 [2.3] days; warfarin: 5.1 [2.7] days; P < .001). Mean (SD) days from first dose to discharge were 2.5 (1.7) (rivaroxaban) and 4.0 (2.9) (warfarin) when initiated with parenteral anticoagulants (P < .001) and 2.7 (1.7) (rivaroxaban) and 4.0 (2.2) (warfarin) without parenteral anticoagulants (P < .001). The rivaroxaban cohort incurred significantly lower unadjusted mean (SD) hospitalization costs (rivaroxaban: $8473 [$9105]; warfarin: $10,291 [$9185]; P < .001), confirmed by covariate adjustment with generalized linear modeling estimating predicted mean hospitalization costs of $8266 for rivaroxaban patients (95% CI, $7851-$8681) and $10,511 for warfarin patients (95% CI, $10,031-$10,992; P < .001).
patients with PE treated with rivaroxaban incurred significantly lower hospitalization costs by $2245 per admission compared with patients treated with warfarin, which was attributable to cost offsets from 1.71 fewer days of stay in the hospital.
本研究利用真实世界数据，比较初始采用利伐沙班口服抗凝治疗与华法林治疗的原发性肺栓塞（PE）患者的住院时间（LOS）和费用。
从2012年11月1日至2013年12月31日，从MarketScan医院药品数据库中选取原发性诊断为PE且初始采用利伐沙班或华法林治疗的成年住院患者。采用精确匹配和倾向评分匹配将华法林治疗患者与利伐沙班治疗患者按1:1进行匹配。评估住院LOS、治疗模式和住院费用。
匹配队列包括751例接受利伐沙班治疗的患者和751例接受华法林治疗的患者。利伐沙班治疗患者的调整后平均LOS为3.77天（95%CI，3.66 - 3.87天），华法林治疗患者为5.48天（95%CI，5.33 - 5.63天；P <.001）。无论入院是因诱因性PE（利伐沙班：5.2[5.1]天；华法林：7.0[6.5]天；P <.001）还是非诱因性PE（利伐沙班：3.4[2.3]天；华法林：5.1[2.7]天；P <.001），服用利伐沙班的患者平均（SD）LOS均较短。初始使用肠外抗凝剂时，从首剂到出院的平均（SD）天数为2.5（1.7）（利伐沙班）和4.0（2.9）（华法林）（P <.001）；未使用肠外抗凝剂时，分别为2.7（1.7）（利伐沙班）和4.0（2.2）（华法林）（P <.001）。利伐沙班组未调整的平均（SD）住院费用显著更低（利伐沙班：8473美元[9105美元]；华法林：10291美元[9185美元]；P <.001），通过广义线性模型进行协变量调整后得到证实，估计利伐沙班治疗患者的预测平均住院费用为8266美元（95%CI，7851 - 8681美元），华法林治疗患者为10511美元（95%CI，10031 - 10992美元；P <.001）。
与接受华法林治疗
