法国非癌症静脉血栓栓塞症患者应用阿哌沙班或 VKAs 治疗的全因医疗资源利用和成本的对比分析。
Comparative Analysis of All-Cause Health Care Resource Utilization and Costs Among Venous Thrombosis Patients Without Cancer Prescribed Apixaban or VKAs in France.
机构信息
Health Economics & Outcomes Research, Pfizer Ltd, Walton Oaks, Tadworth, KT20 7NS, UK.
Evidence and Access, Certara UK, London, UK.
出版信息
Adv Ther. 2022 Aug;39(8):3766-3776. doi: 10.1007/s12325-022-02200-7. Epub 2022 Jun 29.
INTRODUCTION
The direct oral anticoagulant (DOAC) apixaban has shown to have non-inferior efficacy and better safety than vitamin K antagonists (VKAs) in patients with venous thromboembolism (VTE). We determined whether healthcare resource use (HCRU) and direct all-cause medical and non-medical costs in patients with VTE in France differed between VKAs and apixaban.
METHODS
A retrospective cohort study was conducted using French national health data from January 2013-June 2018 for anticoagulant-naïve adults hospitalized with VTE. All-cause costs and HCRU per patient per month (PPPM) were compared between apixaban and VKA cohorts created by 1:1 propensity score matching. Two-part models with bootstrapping were used to calculate marginal effects for costs and HCRU.
RESULTS
The matched VKA and apixaban cohorts each comprised 7503 patients. Compared to VKAs, patients prescribed apixaban had significantly lower (P < 0.0001) mean all-cause costs PPPM for outpatient visits (€438.54 vs. €455.58), overall laboratory tests (€21.26 vs. €83.73), and hospitalizations (€249.48 vs. €343.82), but significantly higher (P < 0.0001) mean all-cause costs PPPM for overall drugs (€97.06 vs. €69.56) and medical procedures (€42.12 vs. €35.50). Mean total all-cause direct medical costs (€687.93 vs. €798.70) and total all-cause direct medical and non-medical costs (€771.60 vs. €883.66) were significantly lower (P < 0.0001) for apixaban. Mean HCRU PPPM showed similar trends. Subgroup analyses showed that, among patients with recurrent VTE, patients prescribed apixaban had significantly lower (P < 0.0001) all-cause costs PPPM for total medical costs (€17.26 vs. €18.12) and total all-cause direct medical and non-medical costs (€18.37 vs. €19.20) than patients prescribed VKAs. Similarly, among patients with bleeding, patients prescribed apixaban had significantly lower (P < 0.0001) all-cause costs PPPM for total medical costs (€15.34 vs. €32.61) and total all-cause direct medical and non-medical costs (€16.23 vs. €34.63) than patients prescribed VKAs.
CONCLUSION
Compared to VKAs, apixaban may be cost-saving in the treatment of patients hospitalized for acute VTE.
介绍
直接口服抗凝剂（DOAC）阿哌沙班在静脉血栓栓塞症（VTE）患者中的疗效不劣于维生素 K 拮抗剂（VKA），安全性更好。我们确定了法国 VTE 患者的医疗资源使用（HCRU）和直接全因医疗和非医疗成本是否因 VKA 和阿哌沙班而有所不同。
方法
使用法国 2013 年 1 月至 2018 年 6 月的全国卫生数据，进行了一项回顾性队列研究，纳入了抗凝初治的 VTE 住院成年患者。通过 1:1 倾向评分匹配，比较了阿哌沙班和 VKA 队列的全因成本和每位患者每月的医疗资源使用（PPPM）。使用 bootstrap 进行两部分模型计算成本和 HCRU 的边际效应。
结果
匹配的 VKA 和阿哌沙班队列各包含 7503 名患者。与 VKA 相比，接受阿哌沙班治疗的患者的全因门诊就诊（€438.54 与 €455.58）、总体实验室检查（€21.26 与 €83.73）和住院（€249.48 与 €343.82）的平均全因成本 PPPM 显著降低（P<0.0001），但总体药物（€97.06 与 €69.56）和医疗程序（€42.12 与 €35.50）的平均全因成本 PPPM 显著升高（P<0.0001）。阿哌沙班的全因直接医疗总费用（€687.93 与 €798.70）和全因直接医疗和非医疗费用（€771.60 与 €883.66）显著降低（P<0.0001）。全因直接医疗和非医疗费用（€18.37 与 €19.20）也显著低于接受 VKA 治疗的患者（P<0.0001）。同样，在出血患者中，接受阿哌沙班治疗的患者的全因医疗费用（€15.34 与 €32.61）和全因直接医疗和非医疗费用（€16.23 与 €34.63）显著低于接受 VKA 治疗的患者（P<0.0001）。
结论
与 VKA 相比，阿哌沙班可能会节省急性 VTE 住院患者的治疗费用。
Zotero 插件