Healthcare Resource Utilization for Oral Anticoagulant Reversal Therapies in Non-Valvular Atrial Fibrillation/Venous Thromboembolism Patients

Abstract

Background:The objective of the study was to describe the healthcare resource utilization (HCRU) and associated costs with hospitalized patients receiving specific versus non-specific oral anticoagulation reversal therapy for life-threatening bleeds and emergency surgeries or urgent procedures.Methods: This retrospective observational study using the Premier Healthcare Database included adult patients aged ≥ 18 years treated with idarucizumab (IDA) or 3-or 4-factor prothrombin complex concentrates (PCC) to reverse the effects of dabigatran or warfarin, respectively, between October 2015 and February 2018.Results: Median ages for IDA (n = 1,232) and PCC (n = 4,939) patients were 78 and 74 years (P < 0.001), respectively. IDA patients had lower bleeding and stroke risk assessment scores (HAS-BLED; P < 0.001 and CHA 2 DS 2 -VASc; P = 0.014) and lower prevalence of comorbidities compared with PCC patients. Median hospital length of stay was 6 and 7 days for patients who received IDA or PCC (P < 0.001), respectively. The percentage of patients with an intensive care unit (ICU) admission was lower for IDA patients compared with PCC patients (61.3% vs. 68.7%; P < 0.001). Median total costs per hospitalization were $19,357 for IDA patients and $26,920 for PCC patients (P < 0.001). Median costs per hospitalization for IDA and PCC treatment were $3,277 and $4,424, respectively. When HCRU and costs were examined by cause of reversal and type of bleed, similar trends in hospitalized costs emerged for IDA compared with PCC treatment.Conclusions: This analysis revealed lower HCRU and total hospital costs in patients administered IDA compared with PCC for reversal of oral anticoagulation, though differences in population characteristics and bleeding events were observed that may have contributed to these findings.

Costs and Healthcare Resource Utilization Associated with Idarucizumab or Andexanet Alfa Oral Anticoagulant Reversal in Patients Hospitalized with Life-Threatening Bleeds

“…In the recently published study by Spyropoulos et al, 11 patients treated with idarucizumab for the reversal of dabigatran had lower ICU admission rate, hospital cost, and shorter LOS, when compared to those treated with a non-specific, PCC-based strategy for the reversal of warfarin. As an extension of that research, the current study revealed that, the patients receiving idarucizumab also had a lower cost than those receiving using andexanet alfa for the specific reversal of DOACs rivaroxaban and apixaban, although the LOS and ICU admission rate were not statistically different among those receiving specific reversal therapies.…”

“…Patients’ health status and risks were captured during the index hospitalization using 3M™ All Patient Refined Diagnosis Related Groups (APR-DRG) Severity of Illness and Risk of Mortality scales, 13 Deyo-Charlson Comorbidity Index (CCI) score, 14 , 15 HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol) score, 16 , 17 CHA 2 DS 2 -VASc schema (Congestive heart failure, Hypertension, Age ≥75 Years, Diabetes mellitus, prior Stroke or transient ischemic attack (TIA), Vascular disease, Age 65–74 years, Sex category) score. 16 , 18 Same set of individual comorbidities as in Spyropoulos et al (2022) 11 were also examined in this study during the index hospitalization, which included bleeds (GIB, ICH), cardiovascular diseases (Coronary Artery Disease (CAD), congestive heart failure (CHF), myocardial infarction (MI), peripheral artery disease (PAD), ischemic stroke/transient ischemic attack (TIA)), renal diseases ;(Chronic Kidney Disease (CKD), Acute Kidney Failure), cardiac procedures (coronary artery bypass grafting (CABG), other open-heart surgery, percutaneous coronary intervention (PCI), other closed cardiac procedures), and other chronic conditions (hypertension, dyslipidemia, cirrhosis/hepatitis, diabetes mellitus, chronic obstructive pulmonary disease (COPD), history of cancer, history of falls, dementia, and depression/anxiety.…”

“… 6 , 10 A recent publication by Spyropoulos et al compared the HCRU and costs between patients treated with idarucizumab for the reversal of dabigatran and those treated with prothrombin complex concentrate for the reversal of warfarin. 11 However, to date, there appears to be no published literature in real-world settings directly comparing the management of major bleeding with specific antidotes to reverse anticoagulation with dabigatran and apixaban/rivaroxaban, respectively. This study utilized a geographically diverse administrative hospital database to address this gap; examine patient, hospital, and clinical characteristics; and determine cost outcomes and hospital resource utilization (HRU) among NVAF and VTE patients admitted to the hospital for life-threatening bleeds.…”