Coleman Craig I, Baugh Christopher, Crivera Concetta, Milentijevic Dejan, Wang Sheng-Wei, Lu Lang, Nelson Winnie W
a University of Connecticut School of Pharmacy , Storrs , CT , USA.
b Brigham & Women's Hospital and Harvard Medical School , Boston , MA , USA.
J Med Econ. 2017 Feb;20(2):200-203. doi: 10.1080/13696998.2016.1243544. Epub 2016 Oct 26.
Rivaroxaban has been shown to have similar efficacy but less major bleeding than warfarin in randomized trials of patients experiencing venous thromboembolism (VTE). This report sought to assess healthcare costs up to 12-months following an index VTE in patients prescribed either rivaroxaban or warfarin.
This study analyzed claims from the MarketScan Commercial Claims and Encounters Database from November 2011-July 2015. It selected adults newly-diagnosed with VTE (deep vein thrombosis [DVT] or pulmonary embolism [PE]) if they had an outpatient prescription claim for rivaroxaban or warfarin within 7-days of the index event. Warfarin users were 2:1 propensity-score matched to rivaroxaban users and followed until the end of insurance coverage, end of data availability or 12-months of follow-up. Total per patient healthcare costs, including inpatient, outpatient, and overall pharmacy costs, were compared using a multivariable generalized linear model.
In total, 10,929 rivaroxaban patients were matched to 21,858 warfarin patients. Mean follow-up for rivaroxaban and warfarin patients was 317- and 321-days for those experiencing an index DVT, and 313- and 318-days for those with PE. Mean overall treatment costs per patient were lower for rivaroxaban vs warfarin users (-$1,116, p = .0016). This cost difference was driven by lower inpatient (-$622) and outpatient (-$1,156) treatment costs, and the higher pharmacy costs ($661) were, therefore, fully offset. Results were similar when analysis was restricted to DVT patients. No significant difference in total costs was observed in patients experiencing an index PE.
Claims databases are subject to inaccuracies and missing data. Prescription claims may not fully reflect actual medication utilization. Despite propensity-score matching and regression, residual confounding cannot be excluded.
Rivaroxaban was associated with significantly lower total per patient VTE treatment costs, despite higher pharmacy costs. These savings are the result of decreased inpatient and outpatient healthcare utilization costs associated with rivaroxaban.
在静脉血栓栓塞症（VTE）患者的随机试验中，已证明利伐沙班与华法林疗效相似，但严重出血情况较少。本报告旨在评估首次发生VTE后接受利伐沙班或华法林治疗的患者长达12个月的医疗费用。
本研究分析了2011年11月至2015年7月MarketScan商业理赔和就诊数据库中的索赔数据。如果成年患者在首次事件发生后7天内有门诊处方索赔记录，且被新诊断为VTE（深静脉血栓形成[DVT]或肺栓塞[PE]），则被纳入研究。华法林使用者与利伐沙班使用者按2:1的倾向得分进行匹配，并随访至保险覆盖结束、数据可用结束或12个月的随访期结束。使用多变量广义线性模型比较每位患者的总医疗费用，包括住院、门诊和总体药房费用。
总共10929名利伐沙班患者与21858名华法林患者进行了匹配。首次发生DVT的利伐沙班和华法林患者的平均随访时间分别为317天和321天，PE患者的平均随访时间分别为313天和318天。利伐沙班使用者的每位患者平均总体治疗费用低于华法林使用者（-1116美元，p = 0.0016）。这种费用差异是由较低的住院（-622美元）和门诊（-1156美元）治疗费用驱动的，因此较高的药房费用（661美元）被完全抵消。当分析仅限于DVT患者时，结果相似。在首次发生PE的患者中，未观察到总费用有显著差异。
索赔数据库可能存在不准确和数据缺失的情况。处方索赔可能无法完全反映实际用药情况。尽管进行了倾向得分匹配和回归分析，但仍无法排除残余混杂因素。
尽管药房费用较高，但利伐沙班与每位患者较低的VTE总治疗费用相关。这些节省是由于与利伐沙班相关的住院和门诊医疗利用成本降低所致。
