a Ochsner Clinic Foundation, Department of Hospital Medicine and The University of Queensland School of Medicine, Ochsner Clinical School , New Orleans , LA , USA.
b Portola Pharmaceuticals , South San Francisco , CA , USA.
J Med Econ. 2017 Dec;20(12):1217-1223. doi: 10.1080/13696998.2017.1362412. Epub 2017 Aug 11.
To evaluate healthcare resource use and costs incurred during, as well as following hospitalization for major bleeding (MB), among atrial fibrillation (AF) patients treated with factor Xa inhibitors Methods: Patients with an AF diagnosis and MB hospitalization (index event) were identified from the MarketScan Commercial and Medicare databases (January 1, 2011-December 31, 2014). Patients were required to have ≥1 prescription for rivaroxaban or apixaban within 3 months prior to MB hospitalization. AF patients treated with Xa inhibitors, but who did not have any diagnosis of MB during the study period were identified. Hospital resource use and costs were evaluated for index MB hospitalizations. Healthcare resource use and associated costs were also evaluated for up to 12 months and compared between AF patients with and without MB.
Of the overall patient population with AF treated with factor Xa inhibitors (n = 92,949), 3,081 (3.3%) were identified as patients with MB and 89,868 without MB. The mean hospital length of stay and hospital cost for index MB hospitalizations were 5.3 days and $28,059, respectively. Total all-cause healthcare costs were higher during the 12 months of follow-up for AF patients with MB vs without ($63,866 vs $37,916, p < .001). After adjusting for differences in patient characteristics, mean total healthcare costs were estimated at $58,169 for patients with MB vs $41,241 for patients without MB.
Since this was an observational study using a claims database analysis, a causal relationship between factor Xa inhibitor treatment and MB events cannot be inferred from the results of this study.
In the real-world setting, the cost of initial hospitalizations for MB was substantial, and the incremental burden of total healthcare costs within 1 year following MB hospitalization was high. Approaches to better manage the continuum of care of AF patients with factor Xa inhibitor-associated MB may reduce the healthcare economic burden.
评估接受 Xa 因子抑制剂治疗的心房颤动（AF）患者因主要出血（MB）住院期间及出院后的医疗资源利用和费用情况。
从 MarketScan 商业和医疗保险数据库（2011 年 1 月 1 日至 2014 年 12 月 31 日）中确定 AF 诊断和 MB 住院（基准事件）的患者。要求患者在 MB 住院前 3 个月内至少有 1 次利伐沙班或阿哌沙班的处方。确定了在研究期间没有任何 MB 诊断但接受 Xa 抑制剂治疗的 AF 患者。评估基准 MB 住院的住院资源利用和费用。还评估了长达 12 个月的医疗资源利用情况和相关费用，并比较了有和无 MB 的 AF 患者之间的差异。
在接受 Xa 因子抑制剂治疗的 AF 总体患者人群中（n=92949），有 3081 例（3.3%）患者被确定为 MB 患者，89868 例患者无 MB。MB 住院指数的平均住院时间和住院费用分别为 5.3 天和 28059 美元。MB 患者在 12 个月的随访期间的总全因医疗费用高于无 MB 患者（63866 美元 vs 37916 美元，p<.001）。在调整了患者特征差异后，MB 患者的平均总医疗费用估计为 58169 美元，无 MB 患者为 41241 美元。
由于这是一项使用索赔数据库分析的观察性研究，因此不能从本研究的结果推断 Xa 因子抑制剂治疗与 MB 事件之间的因果关系。
在实际情况下，MB 初始住院的费用很高，并且在 MB 住院后 1 年内总医疗费用的增量负担很高。采取措施更好地管理接受 Xa 因子抑制剂治疗的 AF 患者的 MB 连续护理，可能会降低医疗保健的经济负担。
