在医疗保险患者中直接口服抗凝剂的利用结果
Prachi Arora1, Maria Muehrcke1, Molly Russell1
1College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN, 46208, USA.
Research in social & administrative pharmacy : RSAP
|July 10, 2023
概括
在非膜性心房动 (NVAF) 或静脉血栓栓塞 (VTE) 的医疗保险患者中,阿皮克萨班在直接口服抗凝剂 (DOAC) 中的坚持率最高. 华法林的停药率最高,而医疗保险计划更倾向于利瓦洛克萨班的覆盖.
科学领域:
- 药物经济学和健康研究成果研究成果
- 心血管医学 心血管医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 直接口服抗凝剂 (DOACs) 是广泛用于非膜性心房动 (NVAF) 和静脉血栓塞栓症 (VTE).
- 了解患者的坚持,坚持和切换模式对于优化治疗结果和管理医疗保健成本至关重要.
研究的目的:
- 为了比较Medicare患者的NVAF或VTE的DOACs (达比加特兰,里瓦罗克萨班,阿皮克萨班,埃多克萨班) 和华法林的坚持,持续性,停止和切换率.
- 分析医疗保险覆盖决定对药物使用和患者自付费用的影响.
主要方法:
- 使用2015-2018年医疗保险D部分索赔数据进行的回顾性观察队列研究.
- 在2016-2017年期间,确定了用特定抗凝剂治疗的NVAF和VTE患者队列.
- 在365天的随访期内评估的坚持 (PDC),持久性,时间到不持久性,停止和转换率.
主要成果:
- 在NVAF和VTE患者中,阿皮克萨班在DOAC中表现出最高的坚持率 (PDC = 76.88%).
- 华法林表现出非持续性和中止率最高的药物.
- 大多数人从达比加特兰转换为其他DOAC,从其他DOAC转换为阿皮克萨班.
- 尽管阿皮克萨班的利用效果优异,但医疗保险计划更倾向于利瓦罗克萨班,导致患者成本降低,但计划支出更高.
结论:
- 与其他DOAC和华法林相比,阿皮克萨班在医疗保险患者中与更好的坚持和持久性有关.
- 医疗保险的覆盖决定可能与最佳药物利用结果不一致,正如利瓦洛克萨班的有利计划覆盖率所示,尽管患者遵守率较低.
- 对抗凝血剂的覆盖决策应包括坚持,持续,停止和切换数据,以确保有效和成本效益的患者护理.
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