Lower Hospitalization and Healthcare Costs With Sacubitril/Valsartan Versus Angiotensin-Converting Enzyme Inhibitor or Angiotensin-Receptor Blocker in a Retrospective Analysis of Patients With Heart Failure
Lower Hospitalization and Healthcare Costs With Sacubitril/Valsartan Versus Angiotensin-Converting Enzyme Inhibitor or Angiotensin-Receptor Blocker in a Retrospective Analysis of Patients With Heart Failure
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DOI：
10.1161/jaha.118.011089
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发表时间：
2019-05-07
影响因子：
5.4
通讯作者：
Chang, Chunlan
中科院分区：
文献类型：
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作者：
Albert, Nancy M.;Swindle, Jason P.;Chang, Chunlan
背景-使用萨舒比利/伐沙坦(SAC/Val)治疗射血分数降低的心力衰竭(HF)患者的结果数据在很大程度上限于临床试验结果。我们比较了接受SAC/Val与血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂(ACEI/ARB)治疗的射血分数降低的心力衰竭患者的住院和医疗费用。方法和结果-使用回顾性管理索赔数据，确定了2015年10月至2016年6月期间接受SAC/Val或ACEI/ARB治疗的心力衰竭患者。在倾向匹配的队列中，使用稳健的方差估计来评估指数后的住院和医疗费用。首次住院时间使用未经调整的Kaplan-Meier估计和多变量模型进行建模。使用调整后的多变量模型对指数化后的全原因医疗费用进行建模。在每个匹配队列的279名患者中，使用Kaplan-Meier估计和未调整的COX模型，SAC/VAL的指数后住院风险低于ACEI/ARB。心力衰竭住院的危险比(95%CI)为0.56(0.33~0.94；P<0.030)。调整后的结果类似于未调整的结果。除药房外，所有类别的SAC/VAL与ACEI/ARB的每月平均(SD)医疗费用都较低，不同队列之间的住院费用差异特别大：心力衰竭住院费用SAC/VAL为248美元(1588美元)，ACEI/ARB为1122美元(7290美元)。与血管紧张素转换酶抑制剂/血管紧张素转换酶抑制剂相比，应用血管紧张素转换酶抑制剂/血管紧张素转换酶抑制剂的心力衰竭患者发生全原因指数后成本增加的调整风险较低(成本比[95%CI]0.74[0.59~0.94]；P=0.013)。结论：在临床实践中，心力衰竭患者应用血管紧张素转换酶/血管紧张素转换酶治疗的射血分数降低的患者住院的可能性低于使用血管紧张素转换酶抑制剂/血管紧张素转换酶抑制剂的患者。尽管药房成本较高，接受SAC/Val治疗的患者每月的医疗和总保健成本较低。
Background-Outcomes data among patients with heart failure (HF) with reduced ejection fraction treated with sacubitril/valsartan (SAC/VAL) are largely limited to clinical trial results. We compared hospitalization and healthcare costs among real-world patients with HF with reduced ejection fraction treated with SAC/VAL versus angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker (ACEI/ARB).Methods and Results-Using retrospective administrative claims data, stable patients with HF with reduced ejection fraction treated with SAC/VAL or ACEI/ARB from October 2015 to June 2016 were identified. Postindex hospitalization and healthcare costs were assessed in propensity-matched cohorts using robust variance estimation. Time to first hospitalization was modeled using unadjusted Kaplan-Meier estimates and multivariable models. Postindex all-cause healthcare costs were modeled using an adjusted multivariable model. Among 279 patients per matched cohort, postindex hospitalization risk was lower for SAC/VAL compared with ACEI/ARB using Kaplan-Meier estimation and unadjusted Cox models. For HF hospitalization, the hazard ratio (95% CI) was 0.56 (0.33-0.94; P 0.030). Adjusted results were similar to unadjusted. Mean (SD) monthly healthcare costs were lower for SAC/VAL versus ACEI/ARB for all categories except pharmacy, with hospital costs being particularly disparate between cohorts: for HF hospitalization, $248 ($1588) for SAC/VAL versus $1122 ($7290) for ACEI/ARB. The adjusted risk of incurring increased all-cause postindex costs was lower for SAC/VAL versus ACEI/ARB (cost ratio [95% CI] 0.74 [0.59-0.94]; P=0.013).Conclusions-In clinical practice, patients with HF with reduced ejection fraction treated with SAC/VAL were less likely to be hospitalized than matched patients treated with ACEI/ARB. Despite higher pharmacy costs, SAC/VAL-treated patients incurred lower monthly medical and total healthcare costs.