Kim Jaehong, Nighohossian Jeremy, Daifotis Anastasia G, He Jinghua, Shafrin Jason
Center for Healthcare Economics and Policy, FTI Consulting, 350 S Grande Ave, Los Angeles, CA 90071. Email:
Am J Manag Care. 2024 Dec;30(12):674-680. doi: 10.37765/ajmc.2024.89639.
To examine the relationship between adoption of direct oral anticoagulants (DOACs) and health and cost outcomes for patients with nonvalvular atrial fibrillation.
Real-world cohort study.
US adults who newly initiated treatment for nonvalvular atrial fibrillation were identified from claims data. DOAC adoption and stroke rates were assessed at metropolitan statistical area (MSA) and individual levels. The MSA-level cross-sectional analysis examined the relationship between the adoption rate of a DOAC (vs warfarin) and an ischemic stroke. The individual-level instrumental variable analysis examined the impact of treatment choice predicted by regional adoption on stroke within 1 year after treatment initiation. Results were extrapolated to estimate the strokes and costs averted by patients moving from a slow-adopting (10th percentile) MSA to a rapid-adopting (90th percentile) MSA.
DOAC uptake rates in MSAs at the 10th and 90th uptake percentile were 53.1% and 78.5%, respectively, in 2014. Overall DOAC uptake increased from 66.3% in 2014 to 91.4% in 2018. Increased DOAC adoption reduced average stroke rates by 1.41 percentage points or 63.2% (P = .002) using the MSA-level descriptive analysis and 1.08 percentage points or 71.2% (P = .002) using the individual-level instrumental variable analysis. Nationally, shifting DOAC rates from those seen in slow-adopting MSAs to those seen in rapid-adopting MSAs could avert up to 32,000 strokes and save up to $1.04 billion annually.
More rapid adoption of newly approved nonvalvular atrial fibrillation treatments was associated with reduced stroke rates and high cost savings. Managed care organizations should consider how delays in the uptake of innovative medications impact health and economic outcomes.
研究非瓣膜性心房颤动患者采用直接口服抗凝剂（DOACs）与健康及成本结果之间的关系。
真实世界队列研究。
从索赔数据中识别出开始接受非瓣膜性心房颤动新治疗的美国成年人。在大都市统计区（MSA）和个体层面评估DOAC的采用情况和中风发生率。MSA层面的横断面分析研究了DOAC（与华法林相比）的采用率与缺血性中风之间的关系。个体层面的工具变量分析研究了区域采用情况预测的治疗选择对治疗开始后1年内中风的影响。结果被外推以估计从采用缓慢（第10百分位数）的MSA转移到采用迅速（第90百分位数）的MSA的患者避免的中风和成本。
2014年，采用率处于第10百分位数和第90百分位数的MSA中，DOAC的采用率分别为53.1%和78.5%。DOAC的总体采用率从2014年的66.3%增至2018年的91.4%。采用MSA层面的描述性分析，DOAC采用率的提高使平均中风发生率降低了1.41个百分点或63.2%（P = 0.002）；采用个体层面的工具变量分析，降低了1.08个百分点或71.2%（P = 0.002）。在全国范围内，将DOAC的采用率从采用缓慢的MSA的水平转变为采用迅速的MSA的水平，每年最多可避免32,000例中风，并节省高达10.4亿美元。
更快地采用新批准的非瓣膜性心房颤动治疗方法与中风发生率降低和高成本节约相关。管理式医疗组织应考虑创新药物采用延迟如何影响健康和经济结果。
