Population Health Research Institute, Hamilton, ON, Canada.
Monash University, Clayton, VIC, Australia.
J Thromb Thrombolysis. 2018 Oct;46(3):310-315. doi: 10.1007/s11239-018-1692-4.
Canadian guidelines recommend non vitamin K antagonists (NOACs) in preference to vitamin K antagonists (VKAs) for stroke prevention in patients with atrial fibrillation (AF), but NOACs are more expensive than VKAs. Canada has a universal healthcare system that covers the cost of NOACs for select patient groups. Ability to pay for NOACs may influence their use. We reviewed medical charts of Hamilton General Hospital outpatients under the age of 65 with a new diagnosis of AF who were referred for initiation of OAC therapy. We contacted these patients by phone and asked them to complete a questionnaire regarding their OAC choice, economic factors that may have influenced this choice (income, insurance) and the financial burden of OAC therapy. We included 110 patients, mean age 56 years, and 26.4% females. NOAC users had a higher median neighborhood income than VKA users (p = 0.0144, n = 110). 73 patients responded to the questionnaire. NOAC users reported higher annual household income (p = 0.0038, n = 73). Patients with private insurance were more likely to use NOACs than those without insurance (p = 0.0496, n = 73). The cost of NOACs and ability to pay is a determinant of their use Ontario patients under the age of 65. This two tiered provision of care appears to contradict the values of Canada's universal healthcare system.
加拿大指南建议，在预防房颤（AF）患者的中风方面，非维生素 K 拮抗剂（NOACs）优于维生素 K 拮抗剂（VKAs），但 NOACs 比 VKAs 更昂贵。加拿大拥有覆盖特定患者群体的 NOAC 费用的全民医疗保健系统。支付能力可能会影响 NOAC 的使用。我们查阅了汉密尔顿综合医院年龄在 65 岁以下、新诊断为 AF 的门诊患者的病历，这些患者被转诊接受 OAC 治疗。我们通过电话联系这些患者，询问他们有关 OAC 选择、可能影响这一选择的经济因素（收入、保险）以及 OAC 治疗的经济负担的问题，并完成了一份问卷。我们共纳入了 110 名患者，平均年龄为 56 岁，其中 26.4%为女性。NOAC 使用者的社区收入中位数高于 VKA 使用者（p=0.0144，n=110）。73 名患者对问卷做出了回应。NOAC 使用者报告的年收入较高（p=0.0038，n=73）。有私人保险的患者比没有保险的患者更有可能使用 NOAC（p=0.0496，n=73）。NOAC 的费用和支付能力是安大略省 65 岁以下患者使用它们的决定因素。这种两级医疗服务的提供方式似乎与加拿大全民医疗保健系统的价值观相矛盾。
