在付款人拒绝阿皮克萨班后,获得抗凝剂的途径
Steven Deitelzweig1, Lin Xie, Emi Terasawa
1Ochsner Health, 1514 Jefferson Hwy, New Orleans, LA 70121.
The American journal of managed care
|November 10, 2023
概括
大多数心房 (AF) 患者在阿皮克萨班排斥后最终接受了口服抗凝剂 (OAC) 治疗. 然而,某些患者群体面临延迟或无法获得OAC治疗.
科学领域:
- 心脏病学 心脏病学
- 卫生经济学 卫生经济学
- 药物经济学 药物经济学
背景情况:
- 获得口服抗凝剂 (OAC) 对于管理心房动 (AF) 至关重要.
- 形式限制,如事先授权,数量限制和形式排除,可以阻碍OAC访问.
- 阿皮克萨班是AF患者常见的OAC.
研究的目的:
- 为了检查由于配方限制而导致阿皮克萨班拒绝后的OAC接入途径.
- 为了确定患者的特征与失败获得OAC治疗后拒绝.
主要方法:
- 对Optum市场清晰度数据的回顾性分析 (2016年1月 - 2020年2月).
- 包括至少一个阿皮克萨班排斥 (PA,FE,QL) 和AF诊断的患者.
- 多变量回归用于评估与在拒绝后60天内没有收到OAC相关的因素.
主要成果:
- 量限制是最常见的拒绝原因 (68.7%).
- 大多数患者 (82.2%-85.5%) 在60天内获得OAC,这表明治疗延迟而不是彻底拒绝.
- 与OAC访问失败相关的因素包括男性性别,非裔美国人种族,医疗补助,高中风险,以前没有使用阿皮克萨班,以及低初始阿皮克萨班剂量.
结论:
- 对于大多数AF患者来说,阿皮克萨班主张的拒绝主要导致OAC访问的暂时延迟.
- 易受伤害的患者群体在最初的拒绝后,没有接受OAC治疗的风险更高.
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