Incremental economic burden associated with major bleeding among atrial fibrillation patients treated with factor Xa inhibitors

Abstract

Objective: To evaluate healthcare resource use and costs incurred during, as well as following hospitalization for major bleeding (MB), among atrial fibrillation (AF) patients treated with factor Xa inhibitors Methods: Patients with an AF diagnosis and MB hospitalization (index event) were identified from the MarketScan Commercial and Medicare databases (January 1, 2011-December 31, 2014. Patients were required to have 1 prescription for rivaroxaban or apixaban within 3 months prior to MB hospitalization. AF patients treated with Xa inhibitors, but who did not have any diagnosis of MB during the study period were identified. Hospital resource use and costs were evaluated for index MB hospitalizations. Healthcare resource use and associated costs were also evaluated for up to 12 months and compared between AF patients with and without MB. Results: Of the overall patient population with AF treated with factor Xa inhibitors (n ¼ 92,949), 3,081 (3.3%) were identified as patients with MB and 89,868 without MB. The mean hospital length of stay and hospital cost for index MB hospitalizations were 5.3 days and $28,059, respectively. Total all-cause healthcare costs were higher during the 12 months of follow-up for AF patients with MB vs without ($63,866 vs $37,916, p < .001). After adjusting for differences in patient characteristics, mean total healthcare costs were estimated at $58,169 for patients with MB vs $41,241 for patients without MB. Limitations: Since this was an observational study using a claims database analysis, a causal relationship between factor Xa inhibitor treatment and MB events cannot be inferred from the results of this study. Conclusion: In the real-world setting, the cost of initial hospitalizations for MB was substantial, and the incremental burden of total healthcare costs within 1 year following MB hospitalization was high. Approaches to better manage the continuum of care of AF patients with factor Xa inhibitor-associated MB may reduce the healthcare economic burden. ARTICLE HISTORY

Burden-of-Illness Associated with Bleeding-Related Hospitalizations in Atrial Fibrillation Patients: Findings from the Nationwide Readmission Database

“…[1][2][3][4][5] In one real-world study of patients with AF who were treated with oral factor Xa inhibitors, those who were hospitalized with a major bleed of any type were found to have mean hospital stays exceeding 5 days and inpatient mortality rates of approximately 3%, though mortality risk was notably higher for patients with intracranial hemorrhage (ICH) (approximately 14%). 4 There is a scarcity of nationally representative data describing the incidence and burden-of-illness of bleeding-related hospitalizations in AF patients, both overall and by bleed subtype. The availability of contemporary data on this topic would allow clinicians and other decision-makers to better understand the absolute and relative risks of detrimental outcomes across various bleeding-related hospitalization types.…”

Comparison of readmissions among hospitalized nonvalvular atrial fibrillation patients treated with oral anticoagulants in the United States

“…The per event readmission costs for MB and stroke among NVAF patients have not been well documented in the published literature. However, a database claims study of patients with an AF diagnosis and a hospitalization for an MB event reported a mean hospital cost of $28,509 per patient (2014 USD) 26 . Costs for hospital readmissions of NVAF patients are substantial and possibly increasing.…”

Management of Factor Xa inhibitor-associated life-threatening major hemorrhage: A retrospective multi-center analysis

“…According to data from the MarketScan databases, approximately 2.9 million people in the U.S. were treated with FXa inhibitors in 2015 [31]. There are currently > 80,000 annual U.S. FXa inhibitor-associated, ISTH-defined major bleeding events [8]. Reversal agents may only be required in a subset, perhaps a third to a half (see Note S1 for explanation), but that number is anticipated to grow, and data presented here contradicts the notion that FXa inhibitor-associated bleeding is mild and reversal agents serve a psychological more than a medical need [32].…”

“…These drugs are easier to manage than VKAs as they do not require routine monitoring of the international normalized ratio and are associated with less intracranial hemorrhage (ICH) [2–5]. Meta-analyses suggest superiority in both safety and efficacy of the newer drugs over VKAs; [6,7] however, serious bleeding still occurs, with an estimated 80,000 cases of major hemorrhage in the U.S. annually on FXa inhibitors alone [8]. …”