AlRuthia Yazed, AlOtaibi Bushra Q, AlOtaibi Reem M, AlOtaibi Najla Q, Alanazi Miteb, Asaad Assiri Ghadah
Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia.
Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia.
Saudi Pharm J. 2023 Jan;31(1):119-124. doi: 10.1016/j.jsps.2022.11.010. Epub 2022 Nov 18.
Rivaroxaban is a novel oral anticoagulant (NOAC) that is commonly used for stroke prevention among patients with atrial fibrillation (AF). However, its cost effectiveness in reducing the risk of hospitalization and mortality in comparison to warfarin among nonvalvular AF patients in Saudi Arabia is largely unknown.
This was a single-center retrospective chart review of adult patients (≥18 years) with nonvalvular AF who were treated with warfarin or rivaroxaban for at least 12 months. Patients with mitral valve stenosis were excluded from the study. Multiple logistic regression was conducted to examine the risk of hospitalization and mortality as a composite outcome, and all annual healthcare costs were captured. Inverse probability treatment weighting with bootstrapping was conducted to determine the mean costs and effectiveness rates.
Two-hundred and twenty-six patients (142 on rivaroxaban and 84 on warfarin) met the inclusion criteria and were included in the analysis. Most of the patients were females (65.91 %), had diabetes (50.57 %) and hypertension (73.76 %), and with a mean age of 68.95 ± 12.55 years. No significant difference in the odds of the composite outcome for rivaroxaban versus warfarin was found (OR = 0.785, 95 % CI = [0.427-1.446], = 0.443). Rivaroxaban resulted in a mean annual cost saving of $13,260.79 with an 87.65 % confidence level that it would be more effective than warfarin with a mean difference in effectiveness rate of 0.168 % (95 % CI [-5.210-18.36]).
Rivaroxaban was associated with lower direct medical costs and non-inferior effectiveness among nonvalvular AF patients in comparison to warfarin.
利伐沙班是一种新型口服抗凝剂（NOAC），常用于预防心房颤动（AF）患者的中风。然而，在沙特阿拉伯非瓣膜性房颤患者中，与华法林相比，其在降低住院风险和死亡率方面的成本效益很大程度上尚不清楚。
这是一项对接受华法林或利伐沙班治疗至少12个月的非瓣膜性房颤成年患者（≥18岁）进行的单中心回顾性病历审查。二尖瓣狭窄患者被排除在研究之外。进行多因素逻辑回归分析以检查住院和死亡风险这一复合结局，并记录所有年度医疗费用。采用自展法进行逆概率处理加权，以确定平均成本和有效率。
226例患者（142例使用利伐沙班，84例使用华法林）符合纳入标准并纳入分析。大多数患者为女性（65.91%），患有糖尿病（50.57%）和高血压（73.76%），平均年龄为68.95±12.55岁。未发现利伐沙班与华法林在复合结局的几率上有显著差异（OR = 0.785，95%CI = [0.427 - 1.446]，P = 0.443）。利伐沙班平均每年节省成本13,260.79美元，有87.65%的置信度表明其比华法林更有效，有效率平均差异为0.168%（95%CI [-5.210 - 18.36]）。
与华法林相比，利伐沙班在非瓣膜性房颤患者中与更低的直接医疗成本和非劣效性疗效相关。
