Masbah Norliana, Macleod Mary Joan
Int J Clin Pharmacol Ther. 2017 Mar;55(3):220-230. doi: 10.5414/CP202651.
Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fibrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial.
This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings.
Hospitalization records over 5 years involving 3,601 stroke patients were analyzed. Direct costs were based on the costs of inpatient length of stay per day. The potential cost savings if AF patients had been on NOACs were estimated using efficacy data from a landmark clinical trial involving rivaroxaban.
Out of the total stroke cases, 29.5% of total stroke cases were secondary to AF, and these cases were more severe with longer hospitalizations. Only 254 patients (39.4%) with confirmed AF were anticoagulated with warfarin prior to admission. AF patients incurred higher median costs (£4,719 (interquartile range (IQR) £1,815 - £12,452) compared to non-AF patients (£3,267 (IQR £1,175 - £11,368)), although the association was statistically insignificant. The use of NOACs in AF-related patients with ischemic strokes would potentially prevent more strokes (leading to 58 fewer cases in comparison to warfarin), resulting in 17.1% in total cost reduction.
CONCLUSION: AF stroke patients incurred higher total direct costs compared to non-AF cases. However, more cost savings were evident with NOACs, due to more strokes being prevented through the use of NOACs compared to warfarin. .
新型口服抗凝药（NOACs）在临床疗效方面被认为是比华法林更好的预防心房颤动（AF）患者中风的替代药物，尽管其药物购置成本更高。
本研究基于苏格兰格兰扁国民医疗服务体系（NHS Grampian）中风患者亚组的住院情况确定直接中风成本，以评估与AF中风相关的成本差异，并确定在该研究人群中使用NOACs是否会节省更多成本。
分析了5年期间涉及3601例中风患者的住院记录。直接成本基于每日住院时间的成本。使用一项涉及利伐沙班的标志性临床试验的疗效数据估算AF患者使用NOACs时潜在的成本节省。
在所有中风病例中，29.5%的中风病例继发于AF，这些病例病情更严重，住院时间更长。入院前仅有254例确诊AF患者（39.4%）接受了华法林抗凝治疗。AF患者的中位成本（4719英镑（四分位间距（IQR）为1815 - 12452英镑））高于非AF患者（3267英镑（IQR为1175 - 11368英镑）），尽管该关联无统计学意义。在与AF相关的缺血性中风患者中使用NOACs可能预防更多中风（与华法林相比减少58例），总成本降低17.1%。
与非AF中风患者相比，AF中风患者的直接总成本更高。然而，由于与华法林相比，使用NOACs预防了更多中风，因此使用NOACs能更显著地节省成本。
