Alberts Mark, He Jinghua, Kharat Akshay, Pericone Christopher D, Ashton Veronica
Hartford HealthCare Hartford CT USA.
Janssen Scientific Affairs LLC, a Johnson & Johnson company Titusville NJ USA.
J Am Heart Assoc. 2025 Jan 21;14(2):e036401. doi: 10.1161/JAHA.124.036401. Epub 2025 Jan 10.
The economic burden of nonvalvular atrial fibrillation (NVAF) is substantial. Many patients with NVAF are obese and manage other health conditions requiring multiple medications. This real-world study compared health care resource use (HRU) and costs for rivaroxaban and warfarin in patients with NVAF who had polypharmacy and obesity.
We used health care claims databases (Merative MarketScan commercial and Medicare supplemental claims) to identify patients initiating the direct oral anticoagulant rivaroxaban or warfarin with ≥1 diagnostic claim for atrial fibrillation, presence of polypharmacy (based on 3 categories for the number of concurrent medications: 1-4, 5-9, ≥10), and obesity. Cohorts were balanced for demographic and baseline characteristics using propensity score matching. All-cause and NVAF-related HRU rates and costs were compared between treatments using rate ratios and adjusted mean differences per patient per year. Eligible patients totaled 95 875, with 19 990 patients in each treatment cohort following propensity score matching. All-cause HRU rates were significantly lower with rivaroxaban versus warfarin, and hospital stays were reduced by 3.1 days with rivaroxaban. Mean (95% CI) all-cause total medical and total health care costs per patient per year were significantly reduced with rivaroxaban versus warfarin (-$4499 [-$5660 to -$3305] and -$1627 [-$2790 to -$438], respectively). NVAF-related HRU was reduced with rivaroxaban versus warfarin, but total NVAF-related medical costs were not significantly different between treatment groups ($144 [-$756 to $1079] per patient per year). Subgroup and sensitivity analysis results were generally consistent with the main analysis.
Among patients with NVAF, polypharmacy, and obesity, rivaroxaban was associated with a reduction in HRU and all-cause costs compared with warfarin.
非瓣膜性心房颤动（NVAF）的经济负担巨大。许多NVAF患者肥胖，且患有其他需要多种药物治疗的健康问题。这项真实世界研究比较了在合并多种药物治疗和肥胖的NVAF患者中，利伐沙班和华法林的医疗资源使用（HRU）及成本。
我们使用医疗理赔数据库（Merative MarketScan商业保险和医疗保险补充理赔数据库），识别出开始使用直接口服抗凝剂利伐沙班或华法林，且有≥1次心房颤动诊断理赔记录、存在多种药物治疗情况（根据同时使用药物数量分为3类：1 - 4种、5 - 9种、≥10种）以及肥胖的患者。使用倾向评分匹配法使各队列在人口统计学和基线特征方面达到平衡。使用率比和每位患者每年的调整后平均差异，比较两种治疗方法之间的全因和NVAF相关的HRU率及成本。符合条件的患者共有95875例，倾向评分匹配后每个治疗队列有19990例患者。与华法林相比，利伐沙班的全因HRU率显著更低，利伐沙班使住院天数减少了3.1天。与华法林相比，利伐沙班使每位患者每年的平均（95%CI）全因总医疗费用和总医疗保健成本显著降低（分别为 - 4499美元[- 5660美元至 - 3305美元]和 - 1627美元[- 2790美元至 - 438美元]）。与华法林相比，利伐沙班降低了NVAF相关的HRU，但治疗组之间的NVAF相关总医疗费用无显著差异（每位患者每年144美元[- 756美元至1079美元]）。亚组分析和敏感性分析结果与主要分析结果总体一致。
在合并多种药物治疗和肥胖的NVAF患者中，与华法林相比，利伐沙班与HRU和全因成本的降低相关。
