University of Illinois at Chicago and Advocate Illinois Masonic Medical Center, Melrose Park, IL, USA.
University of Illinois at Chicago, Advocate Illinois Masonic Medical Center, 101 Madison Street, Suite 300, Oak Park, IL, 60302, USA.
Drugs Aging. 2020 Apr;37(4):281-289. doi: 10.1007/s40266-019-00737-x.
Use of direct-acting oral anticoagulants for patients with nonvalvular atrial fibrillation (NVAF) in skilled nursing facilities (SNFs) is increasing. Rivaroxaban is commonly used in this setting as an alternative to warfarin, based on comparable or increased efficacy in preventing stroke and a similar or lower risk of major bleeding.
The aim of this study was to compare healthcare resource utilization (HCRU) and costs between NVAF patients receiving rivaroxaban or warfarin in SNFs.
This retrospective study examined de-identified claims from Optum Clinformatics Extended Data Mart (1 January 2013-31 December 2017). Eligible patients had an AF diagnosis, were prescribed rivaroxaban or warfarin during an SNF stay, and had one or more such prescriptions filled in the 6 months preceding the stay. Patients were excluded if they received another oral anticoagulant or had evidence of valvular heart disease, mitral stenosis, or organ/tissue transplant. HCRU, mean number of events, and all-cause healthcare costs during the index SNF stay were reported. Results were also reported on a per-patient-per-month (PPPM) basis. Exploratory analyses at different time periods were also conducted.
Overall, 4423 rivaroxaban patients and 22,796 warfarin patients were identified prior to inverse probability of treatment weighting adjustment. Index SNF stay was significantly shorter among rivaroxaban-treated patients (35.8 ± 35.8 days) versus warfarin (40.1 ± 46.3 days; p < 0.0001). During the SNF stay, overall HCRU was lower for the rivaroxaban cohort versus the warfarin cohort. All-cause total costs were significantly reduced for rivaroxaban ($6450 ± $10,379) versus warfarin ($7640 ± $16,556; p < 0.0001), and similar results were observed when calculated on a PPPM basis. During the 1-year post-index period, PPPM all-cause total costs were significantly lower with rivaroxaban versus warfarin ($4135 vs. $4561; p < 0.0001).
In this SNF setting, HCRU and costs were lower among patients with NVAF who were experienced users of rivaroxaban compared with those who were experienced users of warfarin. These findings may help inform clinical decision making to reduce the economic burden of NVAF among older adults in SNFs.
在熟练护理机构（SNF）中，非瓣膜性心房颤动（NVAF）患者使用直接作用的口服抗凝剂的情况正在增加。在这种情况下，利伐沙班通常被用作华法林的替代品，因为它在预防中风方面具有相当或更高的疗效，并且大出血的风险相似或更低。
本研究旨在比较 NVAF 患者在 SNF 中使用利伐沙班或华法林的医疗资源利用（HCRU）和成本。
本回顾性研究使用 Optum Clinformatics 扩展数据集市（2013 年 1 月 1 日至 2017 年 12 月 31 日）的去标识化索赔数据。合格患者的 AF 诊断，在 SNF 期间开具利伐沙班或华法林，并在入住前 6 个月内有一次或多次此类处方。如果患者接受了另一种口服抗凝剂或有瓣膜性心脏病、二尖瓣狭窄或器官/组织移植的证据，则将其排除在外。报告了索引 SNF 入住期间的 HCRU、平均事件数和全因医疗保健费用。还按每位患者每月（PPPM）的基础报告结果。还进行了不同时间段的探索性分析。
总体而言，在进行逆概率治疗加权调整之前，共确定了 4423 名利伐沙班患者和 22796 名利伐沙班患者。与华法林组（40.1 ± 46.3 天；p < 0.0001）相比，利伐沙班组的 SNF 入住时间明显缩短（35.8 ± 35.8 天）。在 SNF 入住期间，利伐沙班组的整体 HCRU 明显低于华法林组。利伐沙班组的全因总费用明显低于华法林组（6450 美元±10379 美元）（7640 美元±16556 美元；p < 0.0001），按 PPPM 计算也得到了类似的结果。在索引后 1 年期间，与华法林相比，利伐沙班组的全因总费用明显更低（4135 美元 vs. 4561 美元；p < 0.0001）。
在这种 SNF 环境中，与华法林的经验使用者相比，利伐沙班的经验使用者 NVAF 患者的 HCRU 和成本较低。这些发现可能有助于为临床决策提供信息，以降低 SNF 中老年人 NVAF 的经济负担。
