Clinical and economic outcomes with rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and obstructive sleep apnea: retrospective analysis of US healthcare claims.

IF 2.1 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Interventional Cardiac Electrophysiology Pub Date : 2024-11-25 DOI:10.1007/s10840-024-01940-6

Andrea Natale, Sanghamitra Mohanty, Cindy Chen, Yuan Zhao, Alicia K Campbell, Brahim Bookhart, Veronica Ashton

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Abstract

Background: Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are often comorbid and associated with increased risk of cardiovascular events such as stroke. We evaluated the effectiveness, safety, healthcare resource utilization, and costs of rivaroxaban versus warfarin in patients with nonvalvular AF (NVAF) and comorbid OSA.

Methods: We used the IQVIA PharMetrics^® Plus adjudicated claims database to evaluate patients with NVAF, OSA, and moderate-to-severe stroke risk who initiated rivaroxaban or warfarin between November 2011 and December 2022. We adjusted for potential confounders with propensity score overlap weighting. Primary endpoints were evaluated based on intent-to-treat (ITT) and on-treatment follow-up to compare stroke or systemic embolism risk, major bleeding risk, all-cause healthcare resource utilization (inpatient hospitalizations, emergency department visits, outpatient visits, and pharmacy fills), and costs (per patient per year [PPPY]) by treatment cohort.

Results: In total, 14,765 patients were included (9133 received rivaroxaban; 5632 received warfarin). Rivaroxaban significantly reduced stroke or systemic embolism versus warfarin by 26% (ITT-hazard ratio, 0.74 [95% CI 0.60-0.91]; P = 0.004) and 30% (on-treatment-hazard ratio, 0.70 [95% CI 0.55-0.89]; P = 0.004). Major bleeding was not significantly different between rivaroxaban and warfarin in either analysis. All-cause healthcare resource utilization was significantly reduced with rivaroxaban versus warfarin, leading to significantly reduced PPPY costs.

Conclusions: Among patients with NVAF and OSA, rivaroxaban was associated with a significant reduction in stroke or systemic embolism risk versus warfarin with no difference in major bleeding. Rivaroxaban significantly reduced healthcare resource utilization and costs compared with warfarin, providing support for the use of rivaroxaban in this population.

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非瓣膜性心房颤动和阻塞性睡眠呼吸暂停患者使用利伐沙班与华法林的临床和经济效果：对美国医疗保健索赔的回顾性分析。

背景：心房颤动（AF）和阻塞性睡眠呼吸暂停（OSA）通常合并存在，并与中风等心血管事件的风险增加有关。我们评估了利伐沙班与华法林在非瓣膜性房颤（NVAF）和合并 OSA 患者中的有效性、安全性、医疗资源利用率和成本：我们使用 IQVIA PharMetrics® Plus 裁判索赔数据库对 2011 年 11 月至 2022 年 12 月期间开始使用利伐沙班或华法林的 NVAF、OSA 和中重度卒中风险患者进行了评估。我们采用倾向得分重叠加权法调整了潜在的混杂因素。主要终点根据意向治疗（ITT）和治疗随访进行评估，比较不同治疗队列的卒中或全身性栓塞风险、大出血风险、全因医疗资源利用率（住院、急诊就诊、门诊就诊和药房配药）和成本（每位患者每年 [PPPY]）：共纳入 14765 名患者（9133 人接受利伐沙班治疗；5632 人接受华法林治疗）。利伐沙班与华法林相比，中风或全身性栓塞明显减少了26%（ITT-危险比，0.74 [95% CI 0.60-0.91]；P = 0.004）和30%（治疗中-危险比，0.70 [95% CI 0.55-0.89]；P = 0.004）。在这两项分析中，利伐沙班与华法林的大出血差异均不大。利伐沙班与华法林相比，全因医疗资源利用率明显降低，从而显著降低了PPPY成本：结论：在 NVAF 和 OSA 患者中，利伐沙班与华法林相比可显著降低中风或全身性栓塞风险，但在大出血方面没有差异。与华法林相比，利伐沙班大大降低了医疗资源的利用率和成本，为在这一人群中使用利伐沙班提供了支持。

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来源期刊

Journal of Interventional Cardiac Electrophysiology 医学-心血管系统

CiteScore

4.30

自引率

11.10%

发文量

320

审稿时长

4-8 weeks

期刊介绍： The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.