Center for Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA, USA.
Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT, USA.
J Med Econ. 2019 Dec;22(12):1338-1350. doi: 10.1080/13696998.2019.1672698. Epub 2019 Oct 12.
Non-valvular atrial fibrillation (NVAF) prevalence increases with age. Hence, evaluating the economic burden among older-aged patients is vital. This study aimed to compare healthcare resource utilization (HRU) and costs among newly-diagnosed older-aged NVAF patients treated with warfarin, rivaroxaban, or apixaban vs. dabigatran. Newly-diagnosed older-aged (aged ≥65 years) NVAF patients initiating dabigatran, warfarin, rivaroxaban, or apixaban (first prescription date = index date) from 01JAN2010-31DEC2015 and with continuous enrollment for ≥12 months pre-index date were included from 100% Medicare database. Patient data were assessed until drug discontinuation/switch/dose change/death/disenrollment/study end (up to 12 months). Dabigatran initiators were 1:1 propensity score-matched (PSM) with warfarin, rivaroxaban, or apixaban initiators. Generalized linear models were used to compare all-cause HRU and costs per-patient-per-month (PPPM) between the matched cohorts. After PSM with dabigatran, 70,531 warfarin, 51,673 rivaroxaban, and 25,209 apixaban patients were identified. Dabigatran patients had significantly fewer generalized-linear-model-adjusted PPPM hospitalizations (0.114 vs. 0.123; 0.111 vs. 0.121), and outpatient visits (2.864 vs. 4.201; 2.839 vs. 2.949) than warfarin and rivaroxaban patients, respectively, but had significantly more PPPM hospitalizations (0.103 vs. 0.090) and outpatient visits (2.780 vs. 2.673) than apixaban patients (all < .0001). Dabigatran patients incurred significantly lower adjusted total PPPM costs ($3,309 vs. $3,362; $3,285 vs. $3,474) than warfarin and rivaroxaban patients, respectively (all < .01) but higher total PPPM costs ($3,192 vs. $2,986) than apixaban patients (all < .0001). This study is subject to the inherent limitations of any claims dataset, including potential bias from coding errors and identification of medical conditions using diagnosis codes as opposed to clinical evidence. Medications filled over-the-counter or provided as samples by the physician are never captured in claims data. Newly-diagnosed older-aged NVAF patients initiating dabigatran incurred significantly lower adjusted all-cause HRU and costs than warfarin and rivaroxaban patients but higher adjusted HRU and costs than apixaban patients.
非瓣膜性心房颤动（NVAF）的患病率随年龄增长而增加。因此，评估老年患者的经济负担至关重要。本研究旨在比较新诊断的老年 NVAF 患者接受华法林、利伐沙班或阿哌沙班与达比加群治疗的医疗资源利用（HRU）和成本。从 2010 年 1 月 1 日至 2015 年 12 月 31 日，从 100%医疗保险数据库中纳入了新诊断的老年（年龄≥65 岁）NVAF 患者，他们开始使用达比加群、华法林、利伐沙班或阿哌沙班（首次处方日期=索引日期），并在索引日期前至少连续 12 个月有资格参加。患者数据评估至药物停药/转换/剂量改变/死亡/退出/研究结束（最长 12 个月）。达比加群的起始者与华法林、利伐沙班或阿哌沙班的起始者进行了 1:1 的倾向评分匹配（PSM）。使用广义线性模型比较匹配队列之间的全因 HRU 和每位患者每月（PPPM）的成本。达比加群进行 PSM 后，确定了 70531 名华法林、51673 名利伐沙班和 25209 名阿哌沙班患者。与华法林和利伐沙班患者相比，达比加群患者的广义线性模型调整后 PPPM 住院（0.114 与 0.123；0.111 与 0.121）和门诊就诊（2.864 与 4.201；2.839 与 2.949）明显减少，但住院（0.103 与 0.090）和门诊就诊（2.780 与 2.673）明显增多，阿哌沙班患者（均<.0001）。达比加群患者的总 PPPM 调整后成本（3309 美元与 3362 美元；3285 美元与 3474 美元）显著低于华法林和利伐沙班患者（均<.01），但高于阿哌沙班患者（3192 美元与 2986 美元）（均<.0001）。本研究存在任何索赔数据集固有的限制，包括编码错误的潜在偏差和使用诊断代码识别医疗状况，而不是临床证据。在索赔数据中，从未捕获到医生开具的非处方或提供的样本药物。新诊断的老年 NVAF 患者开始使用达比加群的全因 HRU 和成本明显低于华法林和利伐沙班患者，但高于阿哌沙班患者。
