New York University School of Medicine, New York, NY, USA.
Analysis Group, Inc, Montréal, QC, Canada.
J Med Econ. 2021 Jan-Dec;24(1):550-562. doi: 10.1080/13696998.2021.1915627.
To assess the real-world healthcare resource utilization (HRU) and costs of patients with non-valvular atrial fibrillation (NVAF) and obesity newly initiated on rivaroxaban or warfarin in the US.
This retrospective study used IQVIA PharMetrics Plus data (01/2010-09/2019) to evaluate patients (≥18 years) with NVAF and obesity (body mass index ≥30 kg/m) initiated on rivaroxaban or warfarin (on or after 01/2013). Inverse probability of treatment weighting (IPTW) was used to adjust for confounding between cohorts. HRU and costs were assessed post-treatment initiation. Weighted cohorts were compared using Poisson regression models and cost differences, with 95% confidence intervals (CIs) and values generated using non-parametric bootstrap procedures.
After IPTW, 10,555 and 5,080 patients were initiated on rivaroxaban and warfarin, respectively (mean age: 59 years). At 12 months follow-up, the rivaroxaban cohort had lower all-cause HRU, including fewer hospitalizations (rate ratio [RR]: 0.80, 95% CI: 0.74, 0.87), emergency room visits (RR: 0.89, 95% CI: 0.83, 0.97), and outpatient visits (RR: 0.72, 95% CI: 0.69, 0.77; all < .05). Medical costs were also reduced in the rivaroxaban cohort (mean difference: -$6,759, 95% CI: -$9,814, -$3,311) due to reduced hospitalization costs (mean difference: -$5,967, 95% CI: -$8,721, -$3,327), resulting in lower total all-cause healthcare costs compared to the warfarin cohort (mean difference: -$4,579, 95% CI: -$7,609, -$1,052; all < .05). The rivaroxaban cohort also had lower NVAF-related HRU and medical costs driven by lower hospitalization at 12 months post-treatment initiation. HRU and cost reductions associated with rivaroxaban persisted up to 36 months of follow-up.
Claims data may have contained inaccuracies and obesity was classified based on ICD diagnosis codes given that patient BMI values were not available.
Rivaroxaban was associated with reduced HRU and costs compared to warfarin among NVAF patients with obesity in a real-world US setting.
评估美国新启用利伐沙班或华法林治疗非瓣膜性心房颤动（NVAF）合并肥胖患者的实际医疗资源利用（HRU）和成本。
本回顾性研究使用 IQVIA PharMetrics Plus 数据（2010 年 1 月至 2019 年 9 月）评估了新启用利伐沙班或华法林（2013 年 1 月及以后）治疗的 NVAF 合并肥胖（BMI≥30kg/m）患者（≥18 岁）。采用逆概率治疗加权法（IPTW）调整队列间混杂因素。治疗开始后评估 HRU 和成本。使用泊松回归模型比较加权队列，并使用非参数自举程序生成具有 95%置信区间（CI）和 值的成本差异。
经 IPTW 后，分别有 10555 例和 5080 例患者新启用利伐沙班和华法林（平均年龄：59 岁）。在 12 个月随访时，利伐沙班组的全因 HRU 较低，包括住院次数（比值比 [RR]：0.80，95%CI：0.74，0.87）、急诊就诊次数（RR：0.89，95%CI：0.83，0.97）和门诊就诊次数（RR：0.72，95%CI：0.69，0.77；均<0.05）减少。由于住院费用降低（RR：-0.5967，95%CI：-0.8721，-0.3311），利伐沙班组的医疗费用也降低（RR：-0.6759，95%CI：-0.9814，-0.3311），与华法林组相比，全因医疗费用更低（RR：-0.4579，95%CI：-0.7609，-0.102；均<0.05）。利伐沙班组在治疗后 12 个月时的 NVAF 相关 HRU 和医疗费用也较低，原因是住院次数减少。在 36 个月的随访期间，利伐沙班组的 HRU 和成本降低仍持续存在。
理赔数据可能存在不准确之处，且由于无法获得患者 BMI 值，因此肥胖是根据 ICD 诊断代码进行分类的。
在真实世界的美国环境中，与华法林相比，利伐沙班可降低 NVAF 合并肥胖患者的 HRU 和成本。
