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Colet JC, Mainar AS, Salazar-Mendiguchía J, del Campo Alonso MI, Echeto A, Larena DV, Sánchez OD. Healthcare resources and costs associated with nonvalvular atrial fibrillation in Spain: apixaban versus acenocoumarol. J Comp Eff Res 2023; 12:e230007. [PMID: 37489950 PMCID: PMC10508311 DOI: 10.57264/cer-2023-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/05/2023] [Indexed: 07/26/2023] Open
Abstract
Aim: Healthcare resources usage and costs associated to nonvalvular atrial fibrillation (NVAF) were analyzed in Spain. Methods: This is an observational and retrospective study on patients with NVAF who started their treatment with apixaban or acenocoumarol between 1 January 2015 and 31 December 2017. Results: 2160 patients treated with apixaban were paired (1:1) with patients treated with acenocoumarol (propensity score matching). Apixaban reduced the incidence of strokes and systemic embolisms, minor and major bleedings and deaths, versus acenocoumarol. Apixaban led to reductions of 80, 55 and 43% in costs related to nursing visits, hospitalizations, and emergency visits, respectively, leading to annual cost savings of €274/patient, from the perspective of society. Conclusion: Our results suggested that apixaban is a cost-effective alternative for patients with NVAF.
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Affiliation(s)
- Josep Comín Colet
- Cardiology Department, Hospital Universitari de Bellvitge (IDIBELL) & CIBERCV, 08907, L'Hospitalet de Llobregat, Spain
| | | | | | | | | | | | - Olga Delgado Sánchez
- Pharmacy Department, Son Espases University Hospital, IdISBa, 07120, Palma, Spain
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Dalmau Llorca MR, Aguilar Martín C, Carrasco-Querol N, Hernández Rojas Z, Forcadell Drago E, Rodríguez Cumplido D, Castro Blanco E, Pepió Vilaubí JM, Gonçalves AQ, Fernández-Sáez J. Gender and Socioeconomic Inequality in the Prescription of Direct Oral Anticoagulants in Patients with Non-Valvular Atrial Fibrillation in Primary Care in Catalonia (Fantas-TIC Study). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010993. [PMID: 34682739 PMCID: PMC8535825 DOI: 10.3390/ijerph182010993] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 12/13/2022]
Abstract
Background: Evidence points to unequal access to direct oral anticoagulant (DOAC) therapy, to the detriment of the most socioeconomically disadvantaged patients in different geographic areas; however, few studies have focused on people with atrial fibrillation. This study aimed to assess gender-based and socioeconomic differences in the prescriptions of anticoagulants in people with non-valvular atrial fibrillation who attended Primary Care. Method: A cross-sectional study with real-world data from patients treated in Primary Care in Catalonia (Spain). Data were obtained from the SIDIAP database, covering 287 Primary Care centers in 2018. Results were presented as descriptive statistics and odds ratios estimated by multivariable logistic regression. Results: A total of 60,978 patients on anticoagulants for non-valvular atrial fibrillation were identified: 41,430 (68%) were taking vitamin K antagonists and 19,548 (32%), DOACs. Women had higher odds of treatment with DOAC (adjusted odds ratio [ORadj] 1.12), while lower DOAC prescription rates affected patients from Primary Care centers located in high-deprivation urban centers (ORadj 0.58) and rural areas (ORadj 0.34). Conclusions: DOAC prescription patterns differ by population. Women are more likely to receive it than men, while people living in rural areas and deprived urban areas are less likely to receive this therapy. Following clinical management guidelines could help to minimize the inequality.
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Affiliation(s)
- Mª Rosa Dalmau Llorca
- Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Catalonia, Spain; (M.R.D.L.); (Z.H.R.); (E.F.D.)
- Campus Terres de l’Ebre, Universitat Rovira i Virgili, 43500 Tortosa, Catalonia, Spain; (E.C.B.); (J.F.-S.)
- Primary Care Intervention Evaluation Research Group (GAVINA Research Group), IDIAPJGol Terres de l’Ebre, 43500 Tortosa, Catalonia, Spain; (C.A.M.); (D.R.C.); (J.M.P.V.)
| | - Carina Aguilar Martín
- Primary Care Intervention Evaluation Research Group (GAVINA Research Group), IDIAPJGol Terres de l’Ebre, 43500 Tortosa, Catalonia, Spain; (C.A.M.); (D.R.C.); (J.M.P.V.)
- Terres de l’Ebre Research Support Unit, Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Catalonia, Spain
- Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Catalonia, Spain
| | - Noèlia Carrasco-Querol
- Primary Care Intervention Evaluation Research Group (GAVINA Research Group), IDIAPJGol Terres de l’Ebre, 43500 Tortosa, Catalonia, Spain; (C.A.M.); (D.R.C.); (J.M.P.V.)
- Terres de l’Ebre Research Support Unit, Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Catalonia, Spain
- Unitat de Recerca, Gerència Territorial Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Catalonia, Spain
- Correspondence: (N.C.-Q.); (A.Q.G.)
| | - Zojaina Hernández Rojas
- Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Catalonia, Spain; (M.R.D.L.); (Z.H.R.); (E.F.D.)
- Campus Terres de l’Ebre, Universitat Rovira i Virgili, 43500 Tortosa, Catalonia, Spain; (E.C.B.); (J.F.-S.)
- Primary Care Intervention Evaluation Research Group (GAVINA Research Group), IDIAPJGol Terres de l’Ebre, 43500 Tortosa, Catalonia, Spain; (C.A.M.); (D.R.C.); (J.M.P.V.)
| | - Emma Forcadell Drago
- Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Catalonia, Spain; (M.R.D.L.); (Z.H.R.); (E.F.D.)
- Primary Care Intervention Evaluation Research Group (GAVINA Research Group), IDIAPJGol Terres de l’Ebre, 43500 Tortosa, Catalonia, Spain; (C.A.M.); (D.R.C.); (J.M.P.V.)
| | - Dolores Rodríguez Cumplido
- Primary Care Intervention Evaluation Research Group (GAVINA Research Group), IDIAPJGol Terres de l’Ebre, 43500 Tortosa, Catalonia, Spain; (C.A.M.); (D.R.C.); (J.M.P.V.)
- Hospital Universitari de Bellvitge, Institut Català de la Salut, 08907 Barcelona, Catalonia, Spain
| | - Elisabet Castro Blanco
- Campus Terres de l’Ebre, Universitat Rovira i Virgili, 43500 Tortosa, Catalonia, Spain; (E.C.B.); (J.F.-S.)
- Primary Care Intervention Evaluation Research Group (GAVINA Research Group), IDIAPJGol Terres de l’Ebre, 43500 Tortosa, Catalonia, Spain; (C.A.M.); (D.R.C.); (J.M.P.V.)
| | - Josep Mª Pepió Vilaubí
- Primary Care Intervention Evaluation Research Group (GAVINA Research Group), IDIAPJGol Terres de l’Ebre, 43500 Tortosa, Catalonia, Spain; (C.A.M.); (D.R.C.); (J.M.P.V.)
| | - Alessandra Queiroga Gonçalves
- Primary Care Intervention Evaluation Research Group (GAVINA Research Group), IDIAPJGol Terres de l’Ebre, 43500 Tortosa, Catalonia, Spain; (C.A.M.); (D.R.C.); (J.M.P.V.)
- Terres de l’Ebre Research Support Unit, Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Catalonia, Spain
- Unitat Docent de Medicina de Familia i Comunitària, Tortosa-Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Catalonia, Spain
- Correspondence: (N.C.-Q.); (A.Q.G.)
| | - José Fernández-Sáez
- Campus Terres de l’Ebre, Universitat Rovira i Virgili, 43500 Tortosa, Catalonia, Spain; (E.C.B.); (J.F.-S.)
- Primary Care Intervention Evaluation Research Group (GAVINA Research Group), IDIAPJGol Terres de l’Ebre, 43500 Tortosa, Catalonia, Spain; (C.A.M.); (D.R.C.); (J.M.P.V.)
- Terres de l’Ebre Research Support Unit, Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Catalonia, Spain
- Unitat de Recerca, Gerència Territorial Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Catalonia, Spain
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Ng CH, Tan DJH, Nistala KRY, Syn N, Xiao J, Tan EXX, Woo FZ, Chew NWS, Huang DQ, Dan YY, Sanyal AJ, Muthiah MD. A network meta-analysis of direct oral anticoagulants for portal vein thrombosis in cirrhosis. Hepatol Int 2021; 15:1196-1206. [PMID: 34417718 DOI: 10.1007/s12072-021-10247-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Current guidelines have limited consensus on the approach to portal venous thrombosis (PVT) in cirrhotic patients. While there is rising interest in direct oral anticoagulants (DOACs) use for PVT, current evidence is limited by small sample size and lack of comparisons to traditional anticoagulants. Thus, a network meta-analysis was conducted to compare the use of DOACs with traditional anticoagulants. METHODS Medline and Embase were searched for articles about anticoagulation use in cirrhotic patients with nontumorous PVT for articles on DOACs, warfarin, low-molecular weight heparin (LMWH) or antithrombin III. A network analysis was conducted using risk ratios (RR) with surface under the cumulative ranking curve (SUCRA). A single-arm meta-analysis was used to summarize the outcomes of DOAC treatment. RESULTS A total of 10 articles were included in the study. 79.5% (CI 38.8-95.9) of DOACs patients achieved complete or partial recanalization and 9.80% (CI 4.50-20.0) experienced a bleeding event. DOACs were superior to LMWH (RR 2.299, CI 1.037-5.093, p = 0.040), warfarin (RR 1.762, CI 1.017-3.053, p = 0.043) and no treatment (RR 3.489, CI 1.394-8.733, p = 0.008) in complete recanalization. For partial recanalization, while DOACs were not superior to any treatment, they had the highest probability in achieving partial recanalization in SUCRA analysis. Bleeding risk and mortality were similar compared to other treatments. CONCLUSION The network analysis supports the use of DOACs in cirrhotic patients, with significant rates of complete recanalization compared to other treatments without increasing bleeding risk. DOACs can potentially be considered for nontumorous PVT in cirrhosis.
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Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | | | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.,Biostatistics and Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Eunice Xiang Xuan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Felicia Zuying Woo
- Department of Pharmacy, National University Hospital, Singapore, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Nicholas W S Chew
- Division of Cardiology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Yock Young Dan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Arun J Sanyal
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore. .,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore. .,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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