Spyropoulos Alex C, Preblick Ron, Kwong Winghan J, Lingohr-Smith Melissa, Lin Jay
1 Department of Medicine, Hofstra Northwell Health School of Medicine, Northwell Health at Lenox Hill Hospital, New York, NY, USA.
2 Daiichi Sankyo, Inc, Parsippany, NJ, USA.
Clin Appl Thromb Hemost. 2017 Sep;23(6):532-541. doi: 10.1177/1076029616680475. Epub 2016 Nov 30.
Clinical and economic outcomes associated with venous thromboembolism (VTE) patient adherence to the American College of Chest Physicians (ACCP) anticoagulant (AC) treatment guidelines are incompletely understood. Patients with ≥1 inpatient or ≥2 separate outpatient claims for deep vein thrombosis and/or pulmonary embolism, based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, were identified from the IMS PharMetrics Plus database. Patients had continuous insurance coverage for 12 months before (baseline) and after (follow-up) the index event (first VTE claim) but no baseline VTE claims. The ACCP recommends minimum AC treatment durations (3 or ≥6 months) dependent upon patient risk profiles. Patients were grouped into study cohorts based on their adherence status (adherent vs nonadherent) to the recommended minimum treatment durations. Patient baseline characteristics, health-care resource utilization, and associated costs were evaluated. The VTE recurrence and bleed-related hospitalization were measured during follow-up. Multivariate regression analysis was utilized to compare clinical and economic outcomes of cohorts. Of the 81 827 study patients, 74% (n = 60 550) were AC adherent. After controlling for key patient characteristics, risks for all-cause hospitalization (adjusted odds ratio [AOR]: 0.85, P < .0001), VTE recurrence (AOR = 0.92, P = .0014), and bleeding-related hospitalization (AOR = 0.74, P < .0001) were lower among adherent patients, as were all-cause health-care cost (-US$2121, P = .0003) and VTE-related (-US$2294, P < .0001) and bleed-related (-US$248, P < .0001) medical costs during the follow-up period. Approximately one-quarter of the study population was AC nonadherent; these nonadherent patients had more VTE recurrences, utilized more inpatient services, and had higher health-care costs.
静脉血栓栓塞症（VTE）患者遵循美国胸科医师学会（ACCP）抗凝（AC）治疗指南所带来的临床和经济结果尚未完全明确。根据国际疾病分类第九版临床修订本编码，从IMS PharMetrics Plus数据库中识别出患有≥1次住院或≥2次单独门诊深静脉血栓形成和/或肺栓塞的患者。患者在索引事件（首次VTE索赔）之前（基线）和之后（随访）连续12个月有保险覆盖，但基线时无VTE索赔。ACCP根据患者风险状况推荐了最低AC治疗持续时间（3或≥6个月）。根据患者对推荐的最低治疗持续时间的依从性状态（依从与不依从）将患者分组到研究队列中。评估患者的基线特征、医疗保健资源利用情况及相关成本。在随访期间测量VTE复发和出血相关住院情况。采用多变量回归分析比较各队列的临床和经济结果。在81827例研究患者中，74%（n = 60550）为AC依从者。在控制关键患者特征后，依从患者的全因住院风险（调整优势比[AOR]：0.85，P <.0001）、VTE复发风险（AOR = 0.92，P =.0014）和出血相关住院风险（AOR = 0.74，P <.0001）较低，随访期间的全因医疗保健成本（-2121美元，P =.0003）、VTE相关成本（-2294美元，P <.0001）和出血相关成本（-248美元，P <.0001）也较低。约四分之一的研究人群为AC不依从者；这些不依从患者有更多的VTE复发，使用了更多的住院服务，且医疗保健成本更高。
