薬剤使用管理戦略が,米国でDOACを投与された非弁動脈細動の患者における臨床イベントの発生率とコストに与える影響
Rupesh Subash1, Elisabeth Vodicka2, Serina Deeba2
1Pfizer Ltd., Walton Oaks, Surrey, United Kingdom.
Journal of medical economics
|September 6, 2025
まとめ
直接投与される経口抗凝固剤 (DOAC) の事前承認 (PA) やステップ療法 (ST) のような薬物使用管理戦略は,非弁動脈動脈症 (NVAF) のメディケア患者の臨床イベントと費用を増加させる. アピキサバンのレベルが上昇すると 脳卒中,出血,死亡が増加しました.
科学分野:
- 薬学経済学
- 医療サービス研究
- クリニカル・アウトカム 研究
背景:
- メディケアプランは,事前承認 (PA),ステップセラピー (ST),処方薬の支出を制御するために,処方薬利用管理 (DUM) 戦略を使用しています.
- これらのDUM戦略は,無意識に治療の遅延,最適でない治療の選択,および患者の自費費の増加につながり,臨床結果に影響を与える可能性があります.
研究 の 目的:
- 非弁性心房動 (NVAF) の米国メディケア患者の臨床イベントおよび関連する費用に対する直接経口抗凝固薬 (DOACs) のアクセス制限とアピキサバンの配方層の上昇の影響をモデル化する.
- 大きな患者集団に対する2つの特定の利用管理戦略の経済的および臨床的影響を定量化する.
主な方法:
- Medicare Fee-For-Service会員1,000,000人の仮設コホートをシミュレートした意思決定モデルを開発し,1年間の臨床イベント発生率とコストを評価した.
- モデル1は,制限されたDOACアクセス (PA/ST) と無制限アクセスを比較した. モデル2では,アピキサバンの投与量増加と投与量増加の欠如を比較し,患者の治療の切り替えや中止の行動を評価した.
主要な成果:
- 制限されたDOACアクセス (PA/ST) は,年間100万人当たり57人の脳卒中,61人の大出血,452人の死亡と関連しており,800万ドル以上の追加費用がかかります.
- アピキサバンの処方値の上昇は,推定330件の脳卒中/全身栓塞,58件の大出血,そして32件の死亡を引き起こし,年間650万ドル以上の費用がかかりました.
結論:
- NVAFの患者に対するDOACの事前承認とステップセラピーの制限は,臨床イベントの増加とメディケアのためのより高い医療費をもたらします.
- アピキサバンなどの特定のDOACの処方値の上昇は,不良臨床イベントと関連するコストの上昇にも貢献し,支払者に悪影響を及ぼします.
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