Comparison of stroke- and bleed-related healthcare resource utilization and costs among patients with newly diagnosed non-valvular atrial fibrillation and newly treated with dabigatran, rivaroxaban, or warfarin

<b>Background</b>: This is one of the first head-to-head real-world evidence studies comparing stroke-related and bleed-related healthcare and resource utilization (HCRU) and costs among non-valvular atrial fibrillation (NVAF) patients initiating oral anticoagulants. <b>Methods</b>: Adult NVAF patients newly diagnosed and treated with dabigatran, rivaroxaban, or warfarin between 10/01/2010 and 12/31/2014 were identified using MarketScan Commercial and Medicare Supplemental databases. Per-patient-per-month stroke and bleed-related HCRU and costs were reported. <b>Results</b>: Dabigatran patients were matched 1:1 to 26,592 rivaroxaban and 33,024 warfarin patients (mean age=68 years). Compared to rivaroxaban, dabigatran patients had lower bleed-related inpatient and outpatient HCRU (0.004 vs. 0.005; 0.099 vs. 0.145) and significantly lower adjusted bleed-related costs ($116 vs. $172), all <i>p</i> &lt;0.05. Compared to warfarin, dabigatran patients had significantly lower stroke-related outpatient visits (0.034 vs. 0.048, <i>p</i>&lt;0.001) and higher bleed-related outpatient visits (0.101 vs. 0.091, <i>p</i>=0.045). Multivariate adjusted bleed-related costs were significantly lower for dabigatran patients than warfarin patients ($94 vs. $138, <i>p</i>&lt;0.001). <b>Conclusions</b>: The results suggest that dabigatran patients had lower bleed-related HCRU and costs than rivaroxaban patients, and lower outpatient stroke-related HCRU, higher bleed-related outpatient HCRU, and lower bleed-related costs than warfarin patients. It provides valuable stroke-related and bleed-related HCRU and costs information among commercially insured and Medicare patients.

<b>背景</b>: 本研究为首批头对头真实世界证据研究之一，旨在对比起始口服抗凝药治疗的非瓣膜性心房颤动（non-valvular atrial fibrillation, NVAF）患者的卒中相关与出血相关医疗保健及资源利用（healthcare and resource utilization, HCRU）与成本差异。<b>方法</b>: 借助MarketScan商业保险与医疗保险补充数据库，筛选2010年10月1日至2014年12月31日期间新确诊并接受达比加群酯、利伐沙班或华法林治疗的成年NVAF患者。统计每患者每月的卒中相关与出血相关HCRU及医疗成本。<b>结果</b>: 达比加群酯患者以1:1比例分别匹配26592名利伐沙班患者与33024名华法林患者（平均年龄68岁）。与利伐沙班组相比，达比加群酯组患者的出血相关住院及门诊HCRU更低（0.004 vs. 0.005; 0.099 vs. 0.145），校正后的出血相关成本亦显著更低（116美元 vs. 172美元），所有*p*<0.05。与华法林组相比，达比加群酯组患者的卒中相关门诊就诊次数显著更低（0.034 vs. 0.048, *p*<0.001），但出血相关门诊就诊次数更高（0.101 vs. 0.091, *p*=0.045）；达比加群酯组的多因素校正后出血相关成本显著低于华法林组（94美元 vs. 138美元, *p*<0.001）。<b>结论</b>: 研究结果显示，达比加群酯患者的出血相关HCRU及成本较利伐沙班组更低；相较于华法林组，其卒中相关门诊HCRU更低、出血相关门诊HCRU更高，且出血相关成本更低。本研究为商业保险参保人群与医疗保险参保人群提供了有价值的卒中相关与出血相关HCRU及成本数据。