Economic burden of rivaroxaban and warfarin among nonvalvular atrial fibrillation patients with obesity and polypharmacy

Abstract

Aim: Evaluate healthcare resource utilization (HRU) and costs associated with rivaroxaban and warfarin among nonvalvular atrial fibrillation (NVAF) patients with obesity and polypharmacy. Materials & methods: IQVIA PharMetrics® Plus (January 2010–September 2019) data were used to identify NVAF patients with obesity (BMI ≥30 kg/m2) and polypharmacy (≥5 medications) initiated on rivaroxaban or warfarin. Weighted rate ratios and cost differences were evaluated post-treatment initiation. Results: Rivaroxaban was associated with significantly lower rates of HRU, including hospitalization (rate ratio [95% CI]: 0.83 [0.77, 0.92]). Medical costs were reduced in rivaroxaban users (difference [95% CI]: -US$6868 [-US$10,628, -US$2954]), resulting in significantly lower total healthcare costs compared with warfarin users (difference [95% CI]: -US$4433 [-US$8136, -US$582]). Conclusion: Rivaroxaban was associated with lower HRU and costs compared with warfarin among NVAF patients with obesity and polypharmacy in commercially insured US patients.

Healthcare Resource Utilization and Costs of Rivaroxaban Versus Warfarin Among Nonvalvular Atrial Fibrillation Patients with Obesity and Diabetes

“…Similar results were obtained for NVAFrelated HRU, with rate ratios significantly lower in the rivaroxaban cohort versus the warfarin cohort for inpatient hospitalizations, ER visits, hospital outpatient visits, and physician office visits (Table 3). NVAF-related mean (SD) lengths of hospital stay were significantly shorter with rivaroxaban versus warfarin for all patients (15 [34] days vs 19 [40] days) and patients with at least one hospitalization (28 [42] days vs 33 [48] days). The exclusion criteria are presented as a funnel approach in which the number of patients in each row reflects those who were retained after applying the respective exclusion criteria in sequential order; the percentages were calculated using the number of patients from the prior row as the denominator b A major bleeding event was identified during the follow-up period using a validated claims-based algorithm developed by Cunningham et al [27] The as-treated sensitivity analysis results for all-cause and NVAF-related HRU rate ratios were consistent with the intent-to-treat analysis, with the additional finding that ER visits were significantly lower in the rivaroxaban cohort versus the warfarin cohort (P \ 0.05; Table 3).…”

“…The lower hospitalization rates and shorter lengths of hospital stay associated with rivaroxaban versus warfarin suggest fewer healthcare interactions in patients treated with rivaroxaban [35,47,48]. These findings may be related to lack of need for routine monitoring and fewer drug-drug interactions with rivaroxaban in comparison to nearly monthly international normalized ratio monitoring that occurs with warfarin [35,46,48]. Although no data have specifically examined HRU costs associated with anticoagulation therapy in patients with NVAF and diabetes, the Nationwide Inpatient Sample registry data found that 29% of AF-related hospitalizations occurred in patients with concurrent diabetes, and there was a temporal increase in the AF hospitalization rate among patients with diabetes [49].…”

“…Outpatient office visits and other visit costs were also lower with rivaroxaban versus warfarin. This claims-based study was extended to evaluate HRU and costs for patients with NVAF, obesity, and polypharmacy (defined as five or more concurrent outpatient prescriptions) [ 48 ]. Rivaroxaban was associated with significantly lower 12- and 36-month HRU and 12-month costs, driven by lower hospitalizations [ 48 ].…”

“…This claims-based study was extended to evaluate HRU and costs for patients with NVAF, obesity, and polypharmacy (defined as five or more concurrent outpatient prescriptions) [ 48 ]. Rivaroxaban was associated with significantly lower 12- and 36-month HRU and 12-month costs, driven by lower hospitalizations [ 48 ]. The lower hospitalization rates and shorter lengths of hospital stay associated with rivaroxaban versus warfarin suggest fewer healthcare interactions in patients treated with rivaroxaban [ 35 , 47 , 48 ].…”

“…Rivaroxaban was associated with significantly lower 12- and 36-month HRU and 12-month costs, driven by lower hospitalizations [ 48 ]. The lower hospitalization rates and shorter lengths of hospital stay associated with rivaroxaban versus warfarin suggest fewer healthcare interactions in patients treated with rivaroxaban [ 35 , 47 , 48 ]. These findings may be related to lack of need for routine monitoring and fewer drug–drug interactions with rivaroxaban in comparison to nearly monthly international normalized ratio monitoring that occurs with warfarin [ 35 , 46 , 48 ].…”