No abstract

Introduction: While clinical trials show improvement in angina symptoms with ranolazine, it is unclear whether this improvement translates into reduced health resource utilization (HRU). We, therefore, sought to analyze whether HRU declined at one year after ranolazine initiation within a large integrated health system. Methods: This was a historical cohort study using nationwide Department of Veterans Affairs (VA) data. We compared participants with a diagnosis of coronary artery disease and chronic stable angina who were prescribed ranolazine, as monotherapy or add-on, following an initial trial of ≥ 1 anti-anginal agent versus alternative secondary agents between 01/01/2006 and 12/31/2013. We addressed confounding through inverse probability (IP) of treatment weighting. We used IP-weighted regression models to evaluate adjusted risk ratios and incident rate ratios for coronary revascularizations, hospitalizations, emergency room (ER) visits, and costs within one year. Results: Of 37,060 patients identified, IP weighted treatment groups comprised 4,766 patients prescribed ranolazine and 32,261 prescribed an alternative agent as their second or third anti-anginal. There were no significant differences in baseline characteristics between treatment groups after IP weighting. In the IP-weighted outcome analysis, coronary artery bypass graft surgeries were significantly lower with ranolazine. All-cause, atrial fibrillation (AF) and heart failure (HF) specific hospitalizations, and total costs were significantly lower in the ranolazine group. Conclusions: Among patients with CSA prescribed a second or third anti-anginal pharmacotherapy, ranolazine was associated with fewer all-cause hospitalizations, hospitalizations for AF and HF, ER visits and total costs. These findings suggest that the reduction in angina symptoms seen in other studies of ranolazine may translate into lower HRU compared to conventional pharmacotherapies.

Background: Real-world data are limited on resource utilization for revascularization procedures and associated healthcare costs for patients treated with ranolazine versus traditional antianginals. Objective: Describe frequency and costs of revascularization procedures among patients with stable ischemic heart disease (SIHD) initiating ranolazine versus traditional antianginals. Methods: Using Marketscan claims databases between 1/1/07-6/30/15, we identified adult patients with one of the following qualifying diagnosis codes: angina (stable or unstable), myocardial infarction, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) who initiated ranolazine or a traditional antianginal (beta-blocker [BB], calcium channel blocker [CCB], or long-acting nitrate [LAN]) as second or third line therapy. To be included, patients had to be continuously enrolled for ≥12 months prior to and after the date of qualifying antianginal prescription. Inverse probability weighting based on propensity score was employed to balance the ranolazine and traditional antianginals cohorts on patient clinical characteristics. Outcomes of interest were frequency and total cost of revascularization procedures (PCI or CABG) over a 12-month follow-up. Results: Analysis included 19,574 patients initiating ranolazine (mean age 67 years; 59.2% male), 23,206 initiating BB (67 years; 57.7% male), 26,225 initiating CCB (67 years; 59.0% male), and 39,736 patients initiating LAN (67 years; 59.1% male). Overall, patients initiating CCB had the lowest rate of revascularization. Fewer ranolazine patients had revascularization procedures than BB and LAN patients. (Table). Ranolazine patients also had fewer hospitalizations with revascularization procedures and shorter length of stay than BB and LAN patients. Healthcare costs associated with revascularization were lower among ranolazine patients ($2933) than among BB ($4465) and LAN ($3609) patients (p<0.001), but similar to CCB patients ($2753, p=0.29). Conclusions: Frequency of revascularization procedures and associated healthcare costs were lower among patients with SIHD initiating ranolazine compared to patients initiating BB or LAN as antianginal therapy, and comparable to patients initiating CCBs.

Introduction: Real-world comparative studies evaluating traditional with newer antianginal medications in chronic stable angina (CSA) on cardiovascular (CV) outcomes and healthcare utilization are limited. Methods: Medical and pharmacy claims from 2008-2012 were analyzed using a large commercial database. Patients with a CSA diagnosis receiving ranolazine, beta blocker (BB), calcium channel blocker (CCB), or long-acting nitrates (nitrates) were identified and followed for 12 months after a change in antianginal therapy. Patients on traditional antianginal medication: BB, CCB, and nitrates were required to have concurrent sublingual nitroglycerin. Therapy change was defined as adding or switching to another traditional antianginal or ranolazine to identify patients who had failed prior therapy. Four groups were identified (BB, CCB, nitrates, or ranolazine users) and matched for age,gender, baseline Charlson Comorbidity Index (CCI), acute coronary syndrome,hypertension, diabetes, heart failure, hyperlipidemia, diabetes related complications, and cardiovascular healthcare costs. Rates for percutaneous intervention (PCI) and coronary bypass graft (CABG) at 30, 60, 90, 180 and 360 days, as well as, annual number of CV-related outpatient visits, emergency room (ER) visits, and inpatient admissions post therapy change were compared between groups. Results: A total of 8008 patients were identified with 2002 patients in each antianginal matched group. The majority (63-65%) were male with a mean age of 66 years and a CCI of 2.89-3.01. The Table summarizes the annual rate per 1000 for CV outcomes. Compared to other antianginal therapies, ranolazine consistently exhibited lower PCI and CABG rates at all time periods following therapy change. Compared to BB, CCB,and nitrates,ranolazine had a 21% (p=0.004), 4% (p=0.578), and 23% (p<0.0001) lower mean number of annual CV inpatient admissions; and 15% (p<0.0001), 4% (p=0.224), and 13% (p<0.0001) lower mean number of annual CV outpatient visits,respectively.Ranolazine had a 17-21% lower mean annual number of CV ER visits compared to the other antianginal groups (p=0.073,p=0.079, p=0.106,respectively). Conclusion: Ranolazine improves CV outcomes and lowers healthcare utilization compared to traditional antianginal therapies.