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

Abstract

IntroductionNew 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.MethodsHealth care claims from the Humana database from 5/2011 to 12/2012 were analyzed. Adult patients newly initiated on rivaroxaban or warfarin with ≥2 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.ResultsMatches 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 < 0.001). Although estimated mean costs of ER visits were higher for rivaroxaban users compared to those of warfarin users, differences were not statistically significant. Including anticoagulant costs, mean overall total all-cause costs were comparable for rivaroxaban versus warfarin users due to cost offset from a reduction in the number and length of hospitalizations and number of outpatient visits ($17,590 vs. $18,676, P = 0.542).ConclusionDespite 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.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0189-1) contains supplementary material, which is available to authorized users.

Real-World Health Care Costs Based on Medication Adherence and Risk of Stroke and Bleeding in Patients Treated with Novel Anticoagulant Therapy

“…The mean total costs for rivaroxaban was slightly lower compared to warfarin ($17,590 vs. $18,676) where higher pharmacy cost for rivaroxaban was offset by lower hospitalization cost. 10 Similar results were found for cost comparison between dabigatran vs warfarin using HealthCore data. 11 Overall, based on the recently published literature, the NOACs tend to demonstrate better or comparable economic outcomes than warfarin but no data exist to highlight the impact of better adherence to NOACs on cost savings.…”

Risk of stroke/systemic embolism, major bleeding and associated costs in non-valvular atrial fibrillation patients who initiated apixaban, dabigatran or rivaroxaban compared with warfarin in the United States Medicare population

“…Lalibert e et al using Premier Perspective Comparative Hospital data demonstrated that rivaroxaban had significantly lower hospitalization cost compared to warfarin ($11,993 vs. $13,255; difference: -$1284; p < .001) per patient during the index hospitalization from 2010 to 2012 29 . Another study by Lalibert e et al also found significantly lower all-cause and AF-related hospitalization costs for rivaroxaban compared to warfarin using Humana data from 2011 to 2012 30 . However, Lalibert e et al did not report costs associated with clinical outcomes: stroke/SE and major bleeding.…”

Anticoagulation Control in Swiss Primary Care: Time in Therapeutic Range Percentages Exceed Benchmarks of Phase III Trials

“…Not only would large quantities of therapy changes challenge patients and clinicians, but the mass of new NOAC prescription would also have relevant economic influence on the country's obligatory health insurance system covering anticoagulant treatment. It has been shown that NOACs can be cost-effective in specific settings despite higher pharmaceutical costs, because overall costs for anticoagulation related outpatient visits and hospitalizations were reduced compared to warfarin treatment [80][81][82][83][84]. However, just like clinical outcomes, also cost-efficiency estimations have been demonstrated to depend on TTR levels achieved in the VKA group [85,86].…”