全因、卒中和出血特异性医疗保健费用：新型抗凝药物达比加群酯或华法林治疗的非瓣膜性心房颤动（NVAF）患者的比较。
All-Cause, Stroke-, and Bleed-Specific Healthcare Costs: Comparison among Patients with Non-Valvular Atrial Fibrillation (NVAF) Newly Treated with Dabigatran or Warfarin.
机构信息
Truven Health Analytics, an IBM Company, 150 Cambridge Park Dr, Cambridge, MA, 02140, USA.
Boehringer-Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA.
出版信息
Am J Cardiovasc Drugs. 2017 Dec;17(6):481-492. doi: 10.1007/s40256-017-0244-1.
OBJECTIVE
Our objective was to compare all-cause and stroke- and bleed-specific healthcare costs among patients with non-valvular atrial fibrillation (NVAF) treated with dabigatran or warfarin.
METHODS
Administrative claims data from the MarketScan Databases for 2009-2014 were used. Patients with NVAF newly treated with dabigatran were matched 1:1 to those treated with warfarin. All-cause and stroke- and bleed-specific costs per patient per month (PPPM) ($US, year 2015 values) up to a 12-month follow-up period were analyzed. Stroke- or bleed-specific costs were defined as hospitalizations with stroke or bleed as the primary discharge diagnosis and outpatient claims with stroke or bleed diagnosis in any position. Differences in costs between dabigatran and warfarin users were assessed using descriptive and multivariate analyses.
RESULTS
A total of 18,980 dabigatran-treated patients were matched to corresponding warfarin-treated patients. Adjusted all-cause total healthcare, inpatient, and outpatient costs were significantly lower for the dabigatran cohort ($US3053 vs. 3433; $US904 vs. 1194; $US1594 vs. 1894, respectively; all p < 0.001), but mean pharmacy costs were significantly higher ($US556 vs. 345, p < 0.001). Stroke-specific total healthcare and outpatient costs were significantly lower for the dabigatran than for the warfarin cohort ($US30.37 vs. 40.99 and $US7.36 vs. 12.20, respectively; p < 0.05 for both values). Similarly, bleed-specific total healthcare and inpatient costs were significantly lower for the dabigatran than for the warfarin cohort ($US50.00 vs. 73.49 and $US27.75 vs. 48.66, respectively; p < 0.01 for both values).
CONCLUSION
Patients receiving dabigatran had significantly lower total all-cause, inpatient, and outpatient costs but higher pharmacy costs than those receiving warfarin. In addition, stroke-specific total and outpatient costs and bleed-specific total and inpatient costs were significantly lower in dabigatran users compared with warfarin users.
目的
我们旨在比较新型口服抗凝药（NOAC）达比加群与华法林治疗非瓣膜性心房颤动（NVAF）患者的全因及卒中/出血特异性医疗保健费用。
方法
使用 2009 年至 2014 年 MarketScan 数据库的行政索赔数据。将新接受达比加群治疗的 NVAF 患者与接受华法林治疗的患者进行 1:1 匹配。分析每位患者每月（PPPM）的全因及卒中/出血特异性成本（$US，2015 年的价值），随访时间最长为 12 个月。卒中/出血特异性成本定义为以卒中或出血为主要出院诊断的住院治疗，以及任何位置诊断为卒中或出血的门诊索赔。使用描述性和多变量分析评估达比加群和华法林使用者之间的成本差异。
结果
共纳入 18980 例达比加群治疗患者，与相应的华法林治疗患者进行匹配。与华法林组相比，达比加群组的全因总医疗保健、住院和门诊费用显著降低（$US3053 比 $US3433；$US904 比 $US1194；$US1594 比 $US1894，均 p＜0.001），但药房费用显著升高（$US556 比 $US345，p＜0.001）。达比加群组的卒中特异性总医疗保健和门诊费用显著低于华法林组（$US30.37 比 $US40.99 和 $US7.36 比 $US12.20，均 p＜0.05）。同样，达比加群组的出血特异性总医疗保健和住院费用也显著低于华法林组（$US50.00 比 $US73.49 和 $US27.75 比 $US48.66，均 p＜0.01）。
结论
与华法林相比，接受达比加群治疗的患者的全因、住院和门诊费用显著降低，但药房费用显著升高。此外，达比加群使用者的卒中特异性总费用和门诊费用以及出血特异性总费用和住院费用均显著低于华法林使用者。
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