两种抗凝治疗策略的医学经济学比较：法国养老院老年患者中维生素 K 拮抗剂与直接口服抗凝剂的比较。“MIKADO”研究。
Medico-economic comparison of two anticoagulant treatment strategies: Vitamin K antagonists vs. direct oral anticoagulants in older adults in nursing homes in France. The "MIKADO" study.
机构信息
Medalice, Le Port Marly, France.
Memory Resource and Research Centre of de Paris-Broca-Ile de France, Hopital Broca, APHP, Paris, France.
出版信息
PLoS One. 2023 Apr 4;18(4):e0283604. doi: 10.1371/journal.pone.0283604. eCollection 2023.
OBJECTIVES
Currently, two classes of oral anticoagulants are available in nursing home residents: vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). DOACs have a higher net clinical benefit than VKAs but DOACs are about 10 times more expensive than VKAs. The objective of our study was to assess and compare the overall costs of anti-coagulant strategy (VKA or DOAC), i.e., including drugs, laboratory costs and time spent in human capital (nurses and medical time) in nursing homes in France.
METHODS
This was an observational, multicenter, prospective study including nine nursing homes in France. Among these nursing homes, 241 patients aged 75 years and older and treated with VKA (n = 140) or DOAC (n = 101) therapy accepted to participate in the study.
RESULTS
During the 3-month follow-up period, the adjusted mean costs per patient were higher for VKA than DOACs for nurse care (€327 (57) vs. €154 (56), p<.0001) for general practitioner care (€297 (91) vs. €204 (91), p = 0.02), for coordinating physicians care (€13 (7) vs. €5 (7), p < 0.07), for laboratory tests (€23 (5) vs. €5 (5), p<.0001), but were lower for drug costs (€8 (3) vs. €165 (3), p<.0001). The average overall cost for 3 months per patient was €668 (140) with VKA vs. €533 (139) with DOAC (p = 0.02).
CONCLUSION
Our study showed that in nursing homes despite a higher drug cost, DOAC therapy is associated with a lower total cost and less time used by nurses and physicians for drug monitoring when compared to VKA.
目的
目前，养老院居民可使用两类口服抗凝剂：维生素 K 拮抗剂（VKA）和直接口服抗凝剂（DOAC）。DOAC 的净临床获益高于 VKA，但 DOAC 比 VKA 贵约 10 倍。本研究的目的是评估和比较抗凝策略（VKA 或 DOAC）的总体成本，即包括药物、实验室成本和人力资本（护士和医疗时间）在法国养老院的花费。
方法
这是一项观察性、多中心、前瞻性研究，包括法国的 9 家养老院。在这些养老院中，241 名年龄在 75 岁及以上、接受 VKA（n = 140）或 DOAC（n = 101）治疗的患者同意参与研究。
结果
在 3 个月的随访期间，VKA 的调整后每位患者的平均成本高于 DOAC 治疗，包括护士护理费用（€327（57）比 €154（56），p＜0.0001）、全科医生护理费用（€297（91）比 €204（91），p = 0.02）、协调医生护理费用（€13（7）比 €5（7），p＜0.07）、实验室检查费用（€23（5）比 €5（5），p＜0.0001），但药物费用较低（€8（3）比 €165（3），p＜0.0001）。VKA 治疗的每位患者 3 个月的平均总费用为€668（140），而 DOAC 治疗为€533（139）（p = 0.02）。
结论
本研究表明，在养老院中，尽管药物成本较高，但与 VKA 相比，DOAC 治疗与较低的总费用相关，并且护士和医生用于药物监测的时间更少。
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