Center for Public Health Research, School of Medicine, University of Milano-Bicocca, Via Cadore 48, I-20900 Monza, Italy.
Formerly Technical University, Munich, Germany.
Eur J Intern Med. 2019 Mar;61:29-33. doi: 10.1016/j.ejim.2018.10.002. Epub 2018 Oct 19.
The non-interventional XALIA study compared the safety and effectiveness of rivaroxaban with standard anticoagulation for the treatment of venous thromboembolism in routine clinical practice. This substudy assessed the effect of treatment with rivaroxaban on healthcare resource use, hospital length of stay (LOS) and frequency of hospitalisation.
In XALIA, patients aged ≥18 years scheduled to receive ≥3 months of rivaroxaban or standard anticoagulation treatment for deep vein thrombosis (DVT) were eligible. Treatment decisions were at the physician's discretion. Healthcare resource use, including hospital admission for the index DVT and initial LOS, was documented. The main analyses in this substudy were conducted in a 1:1 propensity score-matched set (PMS) of patients, with adjustment for cancer at baseline.
In the PMS analysis, 1124 rivaroxaban-treated patients and 1124 standard anticoagulation-treated patients were included. Baseline characteristics were similar between groups (mean age 60.8 years vs. 61.2 years, DVT only rates of 89.7% vs. 90.2% and cancer rates of 8.4% vs. 8.5%, respectively). Of these, 433/1124 (38.5%) rivaroxaban-treated patients and 438/1124 (39.0%) standard anticoagulation-treated patients were hospitalised. Index event LOS in the PMS analysis was a least-squares mean of 2.6 days shorter with rivaroxaban vs. standard anticoagulation (5.4 vs. 8.0 days; geometric means ratio = 0.67 [95% confidence interval 0.61-0.74, P < 0.001]).
In XALIA, hospital LOS was shorter with rivaroxaban than with standard anticoagulation, consistent with the phase III study results. DVT treatment with rivaroxaban in routine clinical practice may reduce the cost per patient vs. standard anticoagulation.
非干预性 XALIA 研究比较了利伐沙班与标准抗凝治疗在常规临床实践中治疗静脉血栓栓塞症的安全性和有效性。这项子研究评估了利伐沙班治疗对医疗资源利用、住院时间（LOS）和住院频率的影响。
在 XALIA 中，年龄≥18 岁的患者计划接受≥3 个月的利伐沙班或标准抗凝治疗深静脉血栓形成（DVT）符合条件。治疗决策由医生决定。记录了医疗资源的利用情况，包括指数 DVT 的住院和初始 LOS。本子研究的主要分析是在患者的 1:1 倾向评分匹配集（PMS）中进行的，调整了基线时的癌症。
在 PMS 分析中，纳入了 1124 名利伐沙班组和 1124 名标准抗凝组患者。两组患者的基线特征相似（平均年龄 60.8 岁与 61.2 岁，仅 DVT 发生率分别为 89.7%与 90.2%，癌症发生率分别为 8.4%与 8.5%）。其中，433/1124（38.5%）名利伐沙班组和 438/1124（39.0%）标准抗凝组患者住院。PMS 分析中，利伐沙班组的指数事件 LOS 比标准抗凝组短 2.6 天（5.4 天 vs. 8.0 天；最小二乘均值比为 0.67[95%置信区间 0.61-0.74，P<0.001]）。
在 XALIA 中，与标准抗凝相比，利伐沙班的住院时间更短，与 III 期研究结果一致。常规临床实践中 DVT 治疗用利伐沙班可能会降低每个患者的成本，优于标准抗凝。
