Amin Alpesh, Keshishian Allison, Vo Lien, Zhang Qisu, Dina Oluwaseyi, Patel Chad, Odell Kevin, Trocio Jeffrey
a UCIMC, University of California , Irvine , CA , USA.
b STATinMED Research , Ann Arbor , MI , USA.
J Med Econ. 2018 Mar;21(3):244-253. doi: 10.1080/13696998.2017.1394866. Epub 2017 Nov 20.
To compare the risk of all-cause hospitalization and hospitalizations due to stroke/systemic embolism (SE) and major bleeding, as well as associated healthcare costs for non-valvular atrial fibrillation (NVAF) patients initiating apixaban, dabigatran, rivaroxaban, or warfarin.
NVAF patients initiating apixaban, dabigatran, rivaroxaban, or warfarin were selected from the OptumInsight Research Database from January 1, 2013-September 30, 2015. Propensity score matching (PSM) was performed between apixaban and each oral anticoagulant. Cox models were used to estimate the risk of stroke/SE and major bleeding. Generalized linear and 2-part models were used to compare healthcare costs.
Of the 47,634 eligible patients, 8,328 warfarin-apixaban pairs, 3,557 dabigatran-apixaban pairs, and 8,440 rivaroxaban-apixaban pairs were matched. Compared to apixaban, warfarin patients were associated with a significantly higher risk of all-cause (hazard ratio [HR] = 1.30; 95% confidence interval [CI] = 1.21-1.40) as well as stroke/SE-related (HR = 1.60; 95% CI = 1.23-2.07) and major bleeding-related (HR = 1.95; 95% CI = 1.60-2.39) hospitalization; rivaroxaban patients were associated with a higher risk of all-cause (HR = 1.15; 95% CI = 1.07-1.24) and major bleeding-related hospitalization (HR = 1.71; 95% CI = 1.39-2.10); and dabigatran patients were associated with a higher risk of major bleeding hospitalization (HR = 1.46, 95% CI = 1.02-2.10). Warfarin patients had significantly higher major bleeding-related and total all-cause healthcare costs compared to apixaban patients. Rivaroxaban patients had significantly higher major bleeding-related costs compared to apixaban patients. No significant results were found for the remaining comparisons.
No causal relationships can be concluded, and unobserved confounders may exist in this retrospective database analysis.
This study demonstrated a significantly higher risk of hospitalization (all-cause, stroke/SE, and major bleeding) associated with warfarin, a significantly higher risk of major bleeding hospitalization associated with dabigatran or rivaroxaban, and a significantly higher risk of all-cause hospitalization associated with rivaroxaban compared to apixaban. Lower major bleeding-related costs were observed for apixaban patients compared to warfarin and rivaroxaban patients.
比较起始使用阿哌沙班、达比加群、利伐沙班或华法林的非瓣膜性心房颤动（NVAF）患者的全因住院风险、因中风/全身性栓塞（SE）和大出血导致的住院风险以及相关医疗费用。
从OptumInsight研究数据库中选取2013年1月1日至2015年9月30日起始使用阿哌沙班、达比加群、利伐沙班或华法林的NVAF患者。对阿哌沙班与每种口服抗凝剂进行倾向评分匹配（PSM）。使用Cox模型估计中风/SE和大出血的风险。使用广义线性模型和两部分模型比较医疗费用。
在47634例符合条件的患者中，匹配了8328对华法林 - 阿哌沙班、3557对达比加群 - 阿哌沙班和8440对利伐沙班 - 阿哌沙班。与阿哌沙班相比，华法林患者的全因（风险比[HR] = 1.30；95%置信区间[CI] = 1.21 - 1.40）以及中风/SE相关（HR = 1.60；95% CI = 1.23 - 2.07）和大出血相关（HR = 1.95；95% CI = 1.60 - 2.39）住院风险显著更高；利伐沙班患者的全因（HR = 1.15；95% CI = 1.07 - 1.24）和大出血相关住院风险更高（HR = 1.71；95% CI = 1.39 - 2.10）；达比加群患者的大出血住院风险更高（HR = 1.46，95% CI = 1.02 - 2.10）。与阿哌沙班患者相比，华法林患者的大出血相关和全因总医疗费用显著更高。与阿哌沙班患者相比，利伐沙班患者的大出血相关费用显著更高。其余比较未发现显著结果。
在这项回顾性数据库分析中无法得出因果关系，可能存在未观察到的混杂因素。
本研究表明，与阿哌沙班相比，华法林相关的住院风险（全因、中风/SE和大出血）显著更高，达比加群或利伐沙班相关的大出血住院风险显著更高，利伐沙班相关的全因住院风险显著更高。与华法林和利伐沙班患者相比，阿哌沙班患者的大出血相关费用更低。
