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

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.

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Abstract P403: Healthcare Resource Utilization and Costs Associated With Oral Anticoagulant Reversal With Idarucizumab or Andexanet Alfa for Patients Hospitalized With Life-Threatening Bleeding Events

Stroke ◽

10.1161/str.52.suppl_1.p403 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Alex Spyropoulos ◽

Briain O Hartaigh ◽

Zhun Cao ◽

Harjeet S Caberwal ◽

Craig Lipkin ◽

...

Keyword(s):

Resource Utilization ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Bleeding Events ◽

Nonvalvular Atrial Fibrillation ◽

Total Hospital ◽

Major Life ◽

Icu Admission ◽

Life Threatening ◽

Andexanet Alfa

Introduction: This study compared healthcare resource utilization and costs associated with the use of idarucizumab for the reversal of dabigatran, and andexanet alfa for the reversal of rivaroxaban/apixaban, in nonvalvular atrial fibrillation (NVAF) and venous thromboembolism (VTE) patients hospitalized with life-threatening bleeds. Methods: This retrospective observational study utilizing the Premier Hospital Database included NVAF and VTE patients aged ≥18 years with a major life-threatening bleed discharged between May 1, 2018 and June 30, 2019 who received idarucizumab or andexanet alfa. Key study outcomes included total hospital and Intensive Care Unit (ICU) length of stay (LOS) and costs, and percentage of patients with an ICU admission. The inverse probability of treatment weighting (IPTW) method was employed to adjust for potential differences in demographic, hospital, visit, and clinical characteristics between treatment cohorts. Results: Idarucizumab patients were older compared with andexanet alfa patients (median age 81 vs. 77 years; p<0.001). Idarucizumab patients were less likely to experience an intracranial hemorrhage (ICH) (73.8% vs. 37.1%; p=0.001), but more likely to have a gastrointestinal bleed (56.3% vs. 24.6%, p<0.001). Idarucizumab patients incurred lower IPTW-adjusted mean total hospital costs compared with andexanet alfa patients ($30,413 ± $33,028 vs. $44,477 ± $30,036; p<0.001). The adjusted mean ICU cost among those with ICU admission was also significantly lower in idarucizumab patients ($25,114 ± $30,433 vs. $43,484 ± $29,335; p<0.001). Notably, the adjusted percentage of ICU admissions, mean hospital and also ICU LOS did not differ appreciably between both cohorts (Table). Conclusions and Discussion: While LOS measures did not differ significantly between patient cohorts, reversal therapy with idarucizumab was associated with lower total hospital and ICU costs as compared with those treated with andexanet alfa.

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