Comparison of differences in medical costs when new oral anticoagulants are used for the treatment of patients with non-valvular atrial fibrillation and venous thromboembolism vs warfarin or placebo in the US

Abstract

Objective:

Medical costs that may be avoided when any of the four new oral anticoagulants (NOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, are used instead of warfarin for the treatment of non-valvular atrial fibrillation (NVAF) were estimated and compared. Additionally, the overall differences in medical costs were estimated for NVAF and venous thromboembolism (VTE) patient populations combined.

Methods:

Medical cost differences associated with NOAC use vs warfarin or placebo among NVAF and VTE patients were estimated based on clinical event rates obtained from the published trial data. The clinical event rates were calculated as the percentage of patients with each of the clinical events during the trial periods. Univariate and multivariate sensitivity analyses were conducted for the medical-cost differences determined for NVAF patients. A hypothetical health plan population of 1 million members was used to estimate and compare the combined medical-cost differences of the NVAF and VTE populations and were projected in the years 2015–2018.

Results:

In a year, the medical-cost differences associated with NOAC use instead of warfarin were estimated at −$204, −$140, −$495, and −$340 per patient for dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. In 2014, among the hypothetical population, the medical-cost differences were −$3.7, −$4.2, −$11.5, and −$6.6 million for NVAF and acute VTE patients treated with dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. In 2014, for the combined NVAF, acute VTE, and extended VTE patient populations, medical-cost differences were −$10.0, −$10.9, −$21.0, and −$21.0 million for dabigatran, rivaroxaban, 2.5 mg apixaban, and 5 mg apixaban, respectively. Medical-cost differences associated with use of NOACs were projected to steadily increase from 2014 to 2018.

Conclusions:

Medical costs are reduced when NOACs are used instead of warfarin/placebo for the treatment of NVAF or VTE, with apixaban being associated with the greatest reduction in medical costs.

Key words::

• Economic model
• Healthcare costs
• New oral anticoagulants
• Non-valvular atrial fibrillation
• Venous thromboembolism

Transparency

Declaration of funding

Sponsorship for this study was provided by Bristol-Myers Squibb and Pfizer.

Declaration of financial/other relationships

AA is a consultant for Novosys Health, which received funding from Bristol-Myers Squibb and Pfizer in connection with conducting this study and development of this manuscript. AB is an employee of Bristol-Myers Squibb and owns stock in the company. JT is an employee of Pfizer and owns stock in the company. JL and MLS are also employees of Novosys Health. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.