Patterns of Initiation of Oral Anticoagulants in Patients with Atrial Fibrillation-Quality and Cost Implications
Patterns of Initiation of Oral Anticoagulants in Patients with Atrial Fibrillation-Quality and Cost Implications
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DOI：
10.1016/j.amjmed.2014.05.013
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发表时间：
2014-11-01
影响因子：
5.9
通讯作者：
Choudhry, Niteesh K.
中科院分区：
文献类型：
--
作者：
Desai, Nihar R.;Krumme, Alexis A.;Choudhry, Niteesh K.
背景技术背景：基于随机试验，达比加群、利伐沙班和阿哌沙班已被批准用于房颤患者，这些试验表明其疗效和安全性与华法林相当或更优，甚至具有上级疗效和安全性。很少有人知道他们的采用到临床实践中，是否利用是一致的对照试验，他们的批准是基于，以及他们的使用如何影响健康支出的患者和insurers.METHODS：我们使用的医疗和处方索赔数据，从一家大型保险公司，以确定患者非瓣膜性房颤谁是规定的口服抗凝剂在2010-2013年。我们绘制了药物治疗开始随时间变化的趋势，评估了相应的保险公司和患者自付费用，并评估了抗凝剂的累积数量和费用。我们使用多变量逻辑模型确定了新抗凝剂启动的预测因素。最后，我们估计的差异，在总药物支出超过6个月的患者开始华法林与一种新的抗凝剂。结果：有6893例房颤患者，在研究期间开始口服抗凝剂。到研究结束时，新型抗凝剂占新处方的62%，占抗凝剂相关药物费用的98%。女性、较低家庭收入、较高CHADS（2）、CHA（2）DS（2）-VASC和HAS-BLED评分与接受新型抗凝剂的几率较低显著相关（P
BACKGROUND: Dabigatran, rivaroxaban, and apixaban have been approved for use in patients with atrial fibrillation based upon randomized trials demonstrating their comparable or superior efficacy and safety relative to warfarin. Little is known about their adoption into clinical practice, whether utilization is consistent with the controlled trials on which their approval was based, and how their use has affected health spending for patients and insurers.METHODS: We used medical and prescription claims data from a large insurer to identify patients with nonvalvular atrial fibrillation who were prescribed an oral anticoagulant in 2010-2013. We plotted trends in medication initiation over time, assessed corresponding insurer and patient out-of-pocket spending, and evaluated the cumulative number and cost of anticoagulants. We identified predictors of novel anticoagulant initiation using multivariable logistic models. Finally, we estimated the difference in total drug expenditures over 6 months for patients initiating warfarin versus a novel anticoagulant.RESULTS: There were 6893 patients with atrial fibrillation that initiated an oral anticoagulant during the study period. By the end of the study period, novel anticoagulants accounted for 62% of new prescriptions and 98% of anticoagulant-related drug costs. Female sex, lower household income, and higher CHADS(2), CHA(2)DS(2)-VASC, and HAS-BLED scores were significantly associated with lower odds of receiving a novel anticoagulant (P