Effect of Rivaroxaban Versus Warfarin on Health Care Costs Among Nonvalvular Atrial Fibrillation Patients: Observations from Rivaroxaban Users and Matched Warfarin Users

详细信息    查看全文

• 作者：Fran?ois Laliberté ; Michel Cloutier ; Concetta Crivera…
• 关键词：Anticoagulant agents ; Atrial fibrillation ; Cost ; Rivaroxaban ; Warfarin
• 刊名：Advances in Therapy
• 出版年：2015
• 出版时间：March 2015
• 年：2015
• 卷：32
• 期：3
• 页码：216-227
• 全文大小：460 KB
• 参考文献：1. Go, AS, Mozaffarian, D, Roger, VL, Benjamin, EJ (2013) Heart disease and stroke statistics-013 update: a report from the American Heart Association. Circulation 127: pp. e6-e245 p://dx.doi.org/10.1161/CIR.0b013e31828124ad" target="_blank" title="It opens in new window">CrossRef
  2. Wolf, PA, Abbott, RD, Kannel, WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 22: pp. 983-988 p://dx.doi.org/10.1161/01.STR.22.8.983" target="_blank" title="It opens in new window">CrossRef
  3. Kim, MH, Johnston, SS, Chu, B-C, Dalal, MR (2011) Estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ Cardiovasc Qual Outcomes. 4: pp. 313-320 p://dx.doi.org/10.1161/CIRCOUTCOMES.110.958165" target="_blank" title="It opens in new window">CrossRef
  4. Wu, EQ, Birnbaum, HG, Mareva, M, Tuttle, E (2005) Economic burden and co-morbidities of atrial fibrillation in a privately insured population. Curr Med Res Opin 21: pp. 1693-1699 p://dx.doi.org/10.1185/030079905X65475" target="_blank" title="It opens in new window">CrossRef
  5. Patel, NJ, Deshmukh, A, Pant, S, Singh, V (2014) Contemporary trends of hospitalization for atrial fibrillation in the United States, 2000 through 2010: implications for healthcare planning. Circulation 129: pp. 2371-2379 p://dx.doi.org/10.1161/CIRCULATIONAHA.114.008201" target="_blank" title="It opens in new window">CrossRef
  6. Ageno, W, Gallus, AS, Wittkowsky, A, Crowther, M (2012) Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141: pp. e44S-e88S
  7. Mantha, S, Cabral, K, Ansell, J (2013) New avenues for anticoagulation in atrial fibrillation. Clin Pharmacol Ther 93: pp. 68-77 p://dx.doi.org/10.1038/clpt.2012.197" target="_blank" title="It opens in new window">CrossRef
  8. U.S. Food and Drug Administration. FDA approves Pradaxa to prevent stroke in people with atrial fibrillation. p://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm230241.htm" class="a-plus-plus">http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm230241.htm. Accessed Feb 2015.
  9. U.S. Food and Drug Administration. FDA approves Xarelto to prevent stroke in people with common type of abnormal heart rhythm. p://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm278646.htm" class="a-plus-plus">http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm278646.htm. Accessed Feb 2015.
  10. U.S. Food and Drug Administration. FDA approves Eliquis to reduce the risk of stroke, blood clots in patients with non-valvular atrial fibrillation. p://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm333634.htm" class="a-plus-plus">http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm333634.htm. Accessed Feb 2015.
  11. Hankey, GJ, Eikelboom, JW (2013) Novel oral anticoagulants for atrial fibrillation. Curr Atheroscler Rep. 15: pp. 344 p://dx.doi.org/10.1007/s11883-013-0344-6" target="_blank" title="It opens in new window">CrossRef
  12. Aditya, S (2012) Oral and parenteral anticoagulants: new kids on the block. J Postgrad Med 58: pp. 275-285 p://dx.doi.org/10.4103/0022-3859.105448" target="_blank" title="It opens in new window">CrossRef
  13. Ansell, J, Hirsh, J, Hylek, E, Jacobson, A (2008) Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133: pp. 160S-198S p://dx.doi.org/10.1378/chest.08-0670" target="_blank" title="It opens in new window">CrossRef
  14. Shafeeq, H, Tran, TH (2014) New oral anticoagulants for atrial fibrillation: are they worth the risk?. P T. 39: pp. 54-64
  15. Lee, S, Anglade, MW, Pham, D, Pisacane, R (2012) Cost-effectiveness of rivaroxaban compared to warfarin for stroke prevention in atrial fibrillation. Am J Cardiol. 110: pp. 845-851 p://dx.doi.org/10.1016/j.amjcard.2012.05.011" target="_blank" title="It opens in new window">CrossRef
  16. Harrington, AR, Armstrong, EP, Nolan, PE, Malone, DC (2013) Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation. Stroke 44: pp. 1676-1681 p://dx.doi.org/10.1161/STROKEAHA.111.000402" target="_blank" title="It opens in new window">CrossRef
  17. Limone, BL, Baker, WL, Kluger, J, Coleman, CI (2013) Novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effective
• 刊物主题：Internal Medicine; Oncology; Cardiology; Rheumatology; Endocrinology; Pharmacology/Toxicology;
• 出版者：Springer Healthcare
• ISSN：1865-8652

文摘

Introduction New target-specific oral anticoagulants may have benefits, such as shorter hospital length of stay, compared to warfarin in patients with nonvalvular atrial fibrillation (NVAF). This study aimed to assess, among patients with NVAF, the effect of rivaroxaban versus warfarin on health care costs in a cohort of rivaroxaban users and matched warfarin users. Methods Health care claims from the Humana database from 5/2011 to 12/2012 were analyzed. Adult patients newly initiated on rivaroxaban or warfarin with?? atrial fibrillation (AF) diagnoses (The International Classification of Diseases, Ninth Revision, Clinical Modification: 427.31) and without valvular AF were identified. Based on propensity score methods, warfarin patients were matched 1:1 to rivaroxaban patients. Patients were observed up to end of data, end of insurance coverage, death, a switch to another anticoagulant, or treatment nonpersistence. Health care costs [hospitalization, emergency room (ER), outpatient, and pharmacy costs] were evaluated using Lin’s method. Results Matches were found for all rivaroxaban patients, and characteristics of the matched groups (n?=?2253 per group) were well balanced. Estimated mean all-cause and AF-related hospitalization costs were significantly lower for rivaroxaban versus warfarin patients (all-cause: $5411 vs. $7427, P?=?0.047; AF-related: $2872 vs. $4147, P?=?0.020). Corresponding estimated mean all-cause outpatient visit costs were also significantly lower, but estimated mean pharmacy costs were significantly higher for rivaroxaban patients ($5316 vs. $2620, P?P?=?0.542). Conclusion Despite higher anticoagulant cost, mean overall total all-cause and AF-related cost remains comparable for patients with NVAF treated with rivaroxaban versus warfarin due to the cost offset from reduced health care resource utilization.