Impact of oral anticoagulation choice on healthcare utilization for the primary treatment of venous thromboembolism.
Impact of oral anticoagulation choice on healthcare utilization for the primary treatment of venous thromboembolism.
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DOI：
10.1177/1358863x20940388
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Zakai NA
中科院分区：
文献类型：
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作者：
Lutsey PL;MacLehose RF;Claxton JS;Walker RF;Adam TJ;Alonso A;Zakai NA
在静脉血栓栓塞（VTE）初始治疗期间，口服抗凝药（OAC）的选择对医疗就诊情况的影响知之甚少。在未使用过抗凝药的VTE患者中，我们验证了以下假设：直接口服抗凝药（DOAC；利伐沙班或阿哌沙班）使用者的医疗利用率低于华法林使用者。使用了2016年和2017年的MarketScan数据库；在初次VTE诊断后的前6个月确定医疗利用率。23864名VTE患者平均住院0.2±0.5次，住院天数为1.3±5.2天，门诊就诊5.7±5.1次，急诊就诊0.4±1.1次。在考虑年龄、性别、合并症和用药情况后，与华法林相比，利伐沙班和阿哌沙班的住院次数、住院天数、门诊就诊次数和急诊就诊次数均较少。与华法林[发生率比（IRR）：1.00（参考值）]相比，利伐沙班的住院率降低24%[发生率比（IRR）：0.76（95%置信区间：0.69，0.83）]，阿哌沙班的住院率降低22%[IRR：0.78（95%置信区间：0.71，0.87）]。阿哌沙班和利伐沙班使用者之间的医疗利用率相似。开具利伐沙班和阿哌沙班的VTE患者的医疗利用率低于开具华法林的患者，而阿哌沙班和利伐沙班相比无差异。这些发现补充了支持使用DOAC而非华法林的现有文献。
Little is known about the impact of oral anticoagulation (OAC) choice on healthcare encounters during VTE primary treatment. Among anticoagulant-naïve patients with VTE we tested the hypotheses that healthcare utilization would be lower among users of direct OACs (DOACs; rivaroxaban or apixaban) than among users of warfarin. MarketScan databases for years 2016 and 2017 were used; healthcare utilization was identified in the first 6 months after initial VTE diagnoses. The 23,864 patients with VTE had on average 0.2±0.5 hospitalizations, spent 1.3±5.2 days in the hospital, had 5.7±5.1 outpatient encounters, and visited an emergency department 0.4±1.1 times. As compared to warfarin, rivaroxaban and apixaban were associated with fewer hospitalizations, days hospitalized, outpatient office visits and emergency department visits, after accounting for age, sex, comorbidities and medications. Hospitalization rates were 24% lower [Incidence Rate Ratio (IRR): 0.76 (95%CI: 0.69, 0.83)] with rivaroxaban and 22% lower [IRR: 0.78 (95%CI: 0.71, 0.87)] with apixaban, as compared to warfarin [IRR: 1.00 (reference)]. Healthcare utilization was similar between apixaban and rivaroxaban users. Patients with VTE prescribed rivaroxaban and apixaban had lower healthcare utilization than did those prescribed warfarin, while there was no difference when comparing apixaban to rivaroxaban. These findings complement existing literature supporting the use of DOACs over warfarin.