Comparative Analysis of All-Cause Health Care Resource Utilization and Costs Among Venous Thrombosis Patients Without Cancer Prescribed Apixaban or VKAs in France
Tóm tắt
The direct oral anticoagulant (DOAC) apixaban has shown to have non-inferior efficacy and better safety than vitamin K antagonists (VKAs) in patients with venous thromboembolism (VTE). We determined whether healthcare resource use (HCRU) and direct all-cause medical and non-medical costs in patients with VTE in France differed between VKAs and apixaban. A retrospective cohort study was conducted using French national health data from January 2013–June 2018 for anticoagulant-naïve adults hospitalized with VTE. All-cause costs and HCRU per patient per month (PPPM) were compared between apixaban and VKA cohorts created by 1:1 propensity score matching. Two-part models with bootstrapping were used to calculate marginal effects for costs and HCRU. The matched VKA and apixaban cohorts each comprised 7503 patients. Compared to VKAs, patients prescribed apixaban had significantly lower (P < 0.0001) mean all-cause costs PPPM for outpatient visits (€438.54 vs. €455.58), overall laboratory tests (€21.26 vs. €83.73), and hospitalizations (€249.48 vs. €343.82), but significantly higher (P < 0.0001) mean all-cause costs PPPM for overall drugs (€97.06 vs. €69.56) and medical procedures (€42.12 vs. €35.50). Mean total all-cause direct medical costs (€687.93 vs. €798.70) and total all-cause direct medical and non-medical costs (€771.60 vs. €883.66) were significantly lower (P < 0.0001) for apixaban. Mean HCRU PPPM showed similar trends. Subgroup analyses showed that, among patients with recurrent VTE, patients prescribed apixaban had significantly lower (P < 0.0001) all-cause costs PPPM for total medical costs (€17.26 vs. €18.12) and total all-cause direct medical and non-medical costs (€18.37 vs. €19.20) than patients prescribed VKAs. Similarly, among patients with bleeding, patients prescribed apixaban had significantly lower (P < 0.0001) all-cause costs PPPM for total medical costs (€15.34 vs. €32.61) and total all-cause direct medical and non-medical costs (€16.23 vs. €34.63) than patients prescribed VKAs. Compared to VKAs, apixaban may be cost-saving in the treatment of patients hospitalized for acute VTE.
Tài liệu tham khảo
Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG, et al. Venous thromboembolism (VTE) in Europe. Thromb Haemost. 2007;98(10):756–64.
Bouée S, Emery C, Samson A, Gourmelen J, Bailly C, Cotté FE. Incidence of venous thromboembolism in France: a retrospective analysis of a national insurance claims database. Thromb J. 2016;14:4.
Allaert FA, Benzenine E, Quantin C. Hospital incidence and annual rates of hospitalization for venous thromboembolic disease in France and the USA. Phlebology. 2017;32(7):443–7.
Engbers MJ, van Hylckama VA, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost. 2010;8(10):2105–12.
Vranckx P, Valgimigli M, Heidbuchel H. The significance of drug–drug and drug–food interactions of oral anticoagulation. Arrhythm Electrophysiol Rev. 2018;7(1):55–61.
Kakkos SK, Kirkilesis GI, Tsolakis IA. Editor’s choice - efficacy and safety of the new oral anticoagulants dabigatran, rivaroxaban, apixaban, and edoxaban in the treatment and secondary prevention of venous thromboembolism: a systematic review and meta-analysis of phase III trials. Eur J Vasc Endovasc Surg. 2014;48(5):565–75.
Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369(9):799–808.
Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315–52.
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543–603.
Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4(19):4693–738.
Barco S, Woersching AL, Spyropoulos AC, Piovella F, Mahan CE. European Union-28: An annualised cost-of-illness model for venous thromboembolism. Thromb Haemost. 2016;115(4):800–8.
Hlavacek P, Guo JD, Rosenblatt L, Keshishian A, Russ C, Mardekian J, et al. Safety, effectiveness, and health care cost comparisons among elderly patients with venous thromboembolism prescribed warfarin or apixaban in the United States Medicare population. Curr Med Res Opin. 2019;35(12):2043–51.
Nielsen A, Poulsen PB, Dybro L, Kloster B, Lorentzen A, Olsen J, et al. Total costs of treating venous thromboembolism: implication of different cost perspectives in a Danish setting. J Med Econ. 2019;22(12):1321–7.
Bertoletti L, Gusto G, Khachatryan A, Quignot N, Chaves J, Moniot A, et al. Effectiveness and safety of oral anticoagulants in the treatment of acute venous thromboembolism: a nationwide comparative cohort study in France. Thromb Haemost. 2022. https://doi.org/10.1055/a-1731-3922.
Jourdi G, Mansour A, Vayne C, Godon A, Tacquard C, Siguret V, et al. Anticoagulation therapy in France: state-of-the-art in 2020. Ann Blood. 2020;5:3.
Haute Autorité de Santé. ELIQUIS (apixaban), oral anticoagulant 2015. https://www.has-sante.fr/jcms/c_2038860/fr/eliquis-apixaban-anticoagulant-par-voie-orale.
ameli.fr. CCAM en ligne: l'Assurance Maladie; 2022. https://www.ameli.fr/accueil-de-la-ccam/index.php.
ameli.fr. Consultations en métropole : vos remboursements: l'Assurance Maladie. 2022. https://www.ameli.fr/assure/remboursements/rembourse/consultations/metropole.
ameli.fr. Base des Médicaments et Informations Tarifaires: L'Assurance Maladie. 2022. http://www.codage.ext.cnamts.fr/codif/bdm_it/index.php?p_site=AMELI.
Insee. Indice des prix à la consommation–base 2015–ensemble des ménages–France–ensemble: L'Institut national de la statistique et des études économiques, France. 2022. https://www.insee.fr/fr/statistiques/serie/001759970#Telechargement.
Belotti F, Deb P, Manning WG, Norton EC. twopm: two-part models. Stata J. 2015;15(1):3–20.
SAS. GENMOD procedure: SAS Institute. 2022. https://support.sas.com/rnd/app/stat/procedures/genmod.html.
Weycker D, Li X, Wygant GD, Lee T, Hamilton M, Luo X, et al. Effectiveness and safety of apixaban versus warfarin as outpatient treatment of venous thromboembolism in U.S. clinical practice. Thromb Haemost. 2018;118(11):1951–61.
Dawwas GK, Smith SM, Dietrich E, Lo-Ciganic WH, Park H. Comparative effectiveness and safety of apixaban versus warfarin in patients with venous thromboembolism. Am J Health Syst Pharm. 2020;77(3):188–95.
Fahrni J, Husmann M, Gretener SB, Keo HH. Assessing the risk of recurrent venous thromboembolism–a practical approach. Vasc Health Risk Manag. 2015;11:451–9.
Klok FA, Huisman MV. How I assess and manage the risk of bleeding in patients treated for venous thromboembolism. Blood. 2020;135(10):724–34.
Streiff M, Milentijevic D, McCrae KR, Laliberté F, Lejeune D, Lefebvre P, et al. Healthcare resource utilization and costs associated with venous thromboembolism in cancer patients treated with anticoagulants. J Med Econ. 2019;22(11):1134–40.
de Jong LA, Dvortsin E, Janssen KJ, Postma MJ. Cost-effectiveness analysis for apixaban in the acute treatment and prevention of venous thromboembolism in the Netherlands. Clin Ther. 2017;39(2):288-302.e4.
Lanitis T, Leipold R, Hamilton M, Rublee D, Quon P, Browne C, et al. Cost-effectiveness of apixaban versus low molecular weight heparin/vitamin k antagonist for the treatment of venous thromboembolism and the prevention of recurrences. BMC Health Serv Res. 2017;17(1):74.
Lanitis T, Leipold R, Hamilton M, Rublee D, Quon P, Browne C, et al. Cost-effectiveness of apixaban versus other oral anticoagulants for the initial treatment of venous thromboembolism and prevention of recurrence. Clin Ther. 2016;38(3):478-93.e16.