Deterioration free discharge comparison of andexanet-alfa and prothrombin complex concentrates (PCC) for reversal of factor Xa inhibitor associated bleeds.

Autor: Keinath JJ; Department of Pharmacy, Henry Ford Health Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI, 48202, USA. jkeinat1@hfhs.org., Lekura J; Syneos Health, Morrisville, USA., Hauser CD; Department of Pharmacy, Indiana University Health Methodist Hospital, Indianapolis, IN, USA., Bajwa MK; Department of Pharmacy, Henry Ford Health Wyandotte Hospital, Wyandotte, MI, USA., Bloome ME; Department of Pharmacy, Henry Ford Health Wyandotte Hospital, Wyandotte, MI, USA., Kalus JS; Department of Pharmacy, Henry Ford Health Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI, 48202, USA., Jones MC; Department of Pharmacy, Henry Ford Health Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI, 48202, USA.
Jazyk: angličtina
Zdroj: Journal of thrombosis and thrombolysis [J Thromb Thrombolysis] 2023 Aug; Vol. 56 (2), pp. 315-322. Date of Electronic Publication: 2023 Jun 08.
DOI: 10.1007/s11239-023-02840-8
Abstrakt: Given the paucity of comparative efficacy data and the difference in cost between andexanet-alfa and prothrombin complex concentrates (PCC), debates continue regarding optimal cost-effective therapy for patients who present with major bleeding associated with oral factor Xa inhibitors. Available literature comparing the cost-effectiveness of the reversal agents is limited, and the large difference in price between therapy options has led many health systems to exclude andexanet-alfa from their formularies. To evaluate the clinical outcomes and cost of PCC compared to andexanet-alfa for patients with factor Xa inhibitor associated bleeds. We performed a quasi-experimental, single health system study of patients treated with PCC or andexanet-alfa from March 2014 to April 2021. Deterioration-free discharge, thrombotic events, length of stay, discharge disposition, and cost were reported. 170 patients were included in the PCC group and 170 patients were included in the andexanet-alfa group. Deterioration-free discharge was achieved in 66.5% of PCC-treated patients compared to 69.4% in the andexanet alfa-treated patients. 31.8% of PCC-treated patients were discharged home compared to 30.6% in the andexanet alfa-treated patients. The cost per deterioration-free discharge was $20,773.62 versus $5230.32 in the andexanet alfa and 4 F-PCC group, respectively. Among patients that experienced a bleed while taking a factor Xa inhibitor, there was no difference in clinical outcomes for patients treated with andexanet-alfa compared to PCC. Although there was no difference in the clinical outcomes, there was a significant difference in cost with andexanet-alfa costing approximately four times as much as PCC per deterioration-free discharge.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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