Patient & Health Impact, Pfizer Inc, New York, NY, USA.
US Health Economics and Outcomes Research, Bristol-Myers Squibb Company, Princeton, NJ, USA.
Curr Med Res Opin. 2019 Dec;35(12):2043-2051. doi: 10.1080/03007995.2019.1653067. Epub 2019 Sep 3.
To compare safety, effectiveness, and healthcare costs of major bleeding (MB), clinically relevant non-major (CRNM) bleeding, recurrent venous thromboembolism (VTE), and all-cause hospitalization among elderly Medicare VTE patients prescribed warfarin vs apixaban. Using 100% Medicare data, elderly patients prescribed apixaban or warfarin within 30 days after a VTE encounter were identified. Patients had continuous health plan enrollment and no parenteral or oral anticoagulant use ≤6 months preceding the VTE encounter. Cohorts were balanced using 1:1 propensity score matching (PSM). Cox proportional hazard models were used to assess the risk of MB, CRNM bleeding, recurrent VTE, and all-cause hospitalization. Generalized linear and two-part models were used to estimate MB-, recurrent VTE-, and all-cause related costs (per patient per month [PPPM]). In the pre-matched cohort, 25,284 (66.9%) patients were prescribed warfarin and 12,515 (33.1%) apixaban. After 1:1 PSM, 11,363 matched pairs of apixaban-warfarin patients were included for a mean follow-up of 4.0 and 4.4 months, respectively. Matched cohorts had a mean age of 78 years and mean Charlson Comorbidity Index score of 2.9. Warfarin was associated with a higher risk of MB (hazard ratio [HR] = 1.31; 95% confidence interval [CI] = 1.10-1.57) and CRNM bleeding (HR = 1.31; 95% CI = 1.19-1.43) vs apixaban. The risks of recurrent VTE (HR = 0.96; 95% CI = 0.70-1.33) and all-cause hospitalization (HR = 1.05; 95% CI = 0.99-1.12) were similar among warfarin and apixaban patients. Warfarin patients had higher MB-related ($147 vs $75; = .003) and all-cause costs PPPM ($3,267 vs $3,033; < .001), but similar recurrent VTE-related medical costs PPPM ($30 vs $36; = .516) vs apixaban patients. Warfarin was associated with significantly higher risk of MB and CRNM bleeding as well as higher MB-related and all-cause costs vs apixaban patients. Recurrent VTE risk and costs were similar among warfarin and apixaban patients.
比较医疗保险老年静脉血栓栓塞患者华法林与阿哌沙班主要出血（MB）、临床相关非主要（CRNM）出血、复发性静脉血栓栓塞（VTE）和全因住院的安全性、有效性和医疗成本。利用 100%的医疗保险数据，确定了在静脉血栓栓塞事件后 30 天内接受阿哌沙班或华法林治疗的老年患者。患者有连续的健康计划参与，并且在静脉血栓栓塞事件发生前≤6 个月没有使用静脉或口服抗凝剂。使用 1:1 倾向评分匹配（PSM）对队列进行平衡。使用 Cox 比例风险模型评估 MB、CRNM 出血、复发性 VTE 和全因住院的风险。使用广义线性和两部分模型估计 MB、复发性 VTE 和全因相关成本（每患者每月[PPPM]）。在预匹配队列中，25284 名（66.9%）患者接受华法林治疗，12515 名（33.1%）患者接受阿哌沙班治疗。经过 1:1 PSM 后，纳入了 11363 对阿哌沙班-华法林患者进行匹配，平均随访时间分别为 4.0 个月和 4.4 个月。匹配队列的平均年龄为 78 岁，平均 Charlson 合并症指数评分为 2.9。与阿哌沙班相比，华法林与 MB（风险比[HR] = 1.31；95%置信区间[CI] = 1.10-1.57）和 CRNM 出血（HR = 1.31；95% CI = 1.19-1.43）的风险增加相关。与华法林患者相比，复发性 VTE（HR = 0.96；95% CI = 0.70-1.33）和全因住院（HR = 1.05；95% CI = 0.99-1.12）的风险相似。华法林患者的 MB 相关费用更高（$147 比 $75； = .003）和全因费用更高 PPPM（$3267 比 $3033； < .001），但复发性 VTE 相关医疗费用 PPPM 相似（$30 比 $36； = .516）与阿哌沙班患者相比。与阿哌沙班患者相比，华法林与 MB 和 CRNM 出血风险显著增加，以及 MB 相关和全因成本更高。与华法林患者相比，阿哌沙班患者的复发性 VTE 风险和成本相似。
