The Cardiovascular Institute, Tokyo, Japan.
Clinical Study Support, Inc, Nagoya, Japan.
J Med Econ. 2020 Dec;23(12):1379-1388. doi: 10.1080/13696998.2020.1824384. Epub 2020 Oct 8.
To compare the hospital length of stay (LOS) between rivaroxaban and warfarin in hospitalized acute stroke patients with non-valvular atrial fibrillation (NVAF) in Japan.
This was a retrospective, observational study using a Japanese hospital claims database. Data of NVAF patients who were started on oral anticoagulant (OAC) treatment during hospitalization were extracted and LOS-OAC (period from the initiation of index OAC therapy to the end of hospitalization or censoring date) and medical costs were compared between rivaroxaban and warfarin treatments. To compare LOS-OAC, a time-to-event analysis was performed using the Kaplan-Meier method. The analysis period was from April 2012 to December 2015.
This study included 773 rivaroxaban users and 1077 warfarin users. After the propensity score matching, 546 patients for each treatment constituted the matched cohorts. Although the rivaroxaban users had a similar LOS-OAC to warfarin users (median, 18 vs. 19 days, = .657) in the matched cohorts, 3 days shorter LOS-OAC was observed in the rivaroxaban users (median, 17 vs. 20 days, = .043) after IPTW adjustment. Subgroup analysis by the severity of stroke after IPTW adjustment demonstrated that rivaroxaban users had a shorter LOS-OAC than warfarin users among patients with mild (median, 10 vs. 14 days) and moderate stroke severity (22 vs. 27 days), but not among those with severe stroke severity (26 vs. 25 days).
It is not possible to say that the only confounder was stroke severity and therefore other possible known and unknown confounders could not be ruled out.
The rivaroxaban users had a 3-day shorter LOS-OAC after IPTW-adjustment. Using rivaroxaban was associated with 4-5 days shorter LOS-OAC than using warfarin in patients with mild or moderate stroke, though treatment selection did not have a large impact in patients with severe stroke.
比较日本住院急性脑卒中合并非瓣膜性心房颤动（NVAF）患者使用利伐沙班和华法林的住院时间（LOS）。
这是一项使用日本医院理赔数据库的回顾性观察性研究。提取开始口服抗凝剂（OAC）治疗的 NVAF 患者的数据，并比较利伐沙班和华法林治疗的 OAC 住院时间（LOS-OAC，从开始指数 OAC 治疗到出院或截止日期的时间段）和医疗费用。为了比较 LOS-OAC，采用 Kaplan-Meier 方法进行时间事件分析。分析期为 2012 年 4 月至 2015 年 12 月。
本研究纳入了 773 名利伐沙班使用者和 1077 名华法林使用者。在进行倾向评分匹配后，每组治疗各有 546 名患者构成匹配队列。尽管匹配队列中利伐沙班使用者的 LOS-OAC 与华法林使用者相似（中位数，18 天与 19 天，P=.657），但 IPTW 调整后利伐沙班使用者的 LOS-OAC 短 3 天（中位数，17 天与 20 天，P=.043）。根据 IPTW 调整后的卒中严重程度进行亚组分析显示，在轻度（中位数，10 天与 14 天）和中度卒中严重程度（22 天与 27 天）的患者中，利伐沙班使用者的 LOS-OAC 短于华法林使用者，但在重度卒中严重程度的患者中（26 天与 25 天）并非如此。
不能说唯一的混杂因素是卒中严重程度，因此不能排除其他已知和未知的混杂因素。
在 IPTW 调整后，利伐沙班使用者的 LOS-OAC 短 3 天。与华法林相比，在轻度或中度卒中患者中，使用利伐沙班可使 LOS-OAC 缩短 4-5 天，但在重度卒中患者中，治疗选择的影响不大。
