Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA.
Am J Cardiovasc Drugs. 2018 Dec;18(6):513-520. doi: 10.1007/s40256-018-0296-x.
Our objective was to evaluate the association between switching from warfarin to non-vitamin K oral anticoagulants (NOACs) and potential drug-drug interactions (DDIs), healthcare utilization, and expenditures in working-age adults with atrial fibrillation (AF).
We conducted a retrospective cohort study using data from 2010 to 2015 for patients who switched from warfarin to NOACs (switchers) and those who continued to receive warfarin (non-switchers). We identified medications known or suspected to have clinically significant interactions with NOACs or warfarin. We used multivariate logistic regression, negative binomial, and generalized linear models to evaluate the influence of switching to NOACs and of potential DDIs on inpatient visits, outpatient visits, number of outpatient visits, and non-drug medical expenditures. Inverse probability of treatment weighting was also applied in analyses.
A total of 4126 patients with AF were included in the study. Switching to NOACs was significantly and negatively related to the number of outpatient, inpatient, and emergency room (ER) visits and non-drug medical expenditures. When potential DDIs were included in the models, switching remained significantly associated only with reduced inpatient and outpatient visits. Notably, having at least one potential DDI was associated with an increased likelihood of ER visits and the number of outpatient visits; it was also significantly and positively associated with non-drug medical expenditures.
Relative to persistent warfarin use, switching to NOACs was associated with fewer inpatient, ER, and outpatient visits and lower non-drug costs. Potential DDIs were also strongly and positively associated with healthcare utilization and expenditures. Both are critical to consider in the management of AF in working-age adults.
我们旨在评估从华法林转换为非维生素 K 口服抗凝剂（NOACs）与潜在药物-药物相互作用（DDI）、医疗保健利用和工作年龄成年人房颤（AF）的支出之间的关联。
我们使用 2010 年至 2015 年的数据进行了回顾性队列研究，纳入了从华法林转换为 NOACs 的患者（转换者）和继续接受华法林治疗的患者（非转换者）。我们确定了已知或疑似与 NOACs 或华法林有临床显著相互作用的药物。我们使用多变量逻辑回归、负二项式和广义线性模型评估转换为 NOACs 和潜在 DDI 对住院就诊、门诊就诊、门诊就诊次数和非药物医疗支出的影响。在分析中还应用了逆概率治疗加权。
共有 4126 例 AF 患者纳入研究。与非转换者相比，转换为 NOACs 与门诊、住院和急诊就诊次数和非药物医疗支出显著减少相关。当将潜在 DDI 纳入模型时，转换仅与住院和门诊就诊次数减少显著相关。值得注意的是，至少有一种潜在的 DDI 与急诊就诊次数和门诊就诊次数增加相关，并且与非药物医疗支出显著正相关。
与持续使用华法林相比，转换为 NOACs 与住院、急诊和门诊就诊次数减少和非药物成本降低相关。潜在的 DDI 也与医疗保健利用和支出呈强烈正相关。在管理工作年龄成年人的 AF 时，这两者都至关重要。
