![Sample our Bioscience journals, sign in here to start your access, Latest two full volumes FREE to you for 14 days]({"type":"image" , "src" : "/sda/5925/TOC-Subject-Sample-2021-Bioscience.jpg"})
Abstract
Objective
Atrial fibrillation (AF) is present in up to 17% of patients in skilled nursing facilities (SNFs). This study compared healthcare resource utilization (HRU) and costs between AF patients initiating rivaroxaban or warfarin in SNFs.
Methods
Using de-identified claims from Optum Clinformatics Extended Data Mart (1 January 2013 to 31 December 2017), this retrospective cohort study indexed AF patients with first SNF admission during which rivaroxaban or warfarin was initiated within 3 days of admission. To adjust for selection bias, inverse probability of treatment weighting (IPTW) was applied for baseline characteristics. Logistic regression and generalized linear models were used to compare HRU and costs.
Results
519 rivaroxaban and 1129 warfarin patients met inclusion criteria. After IPTW, the cohorts were well balanced for baseline characteristics. The average length of index SNF stay was 32.07 and 37.44 days for rivaroxaban and warfarin patients, respectively. During SNF stay, rivaroxaban patients had 27% lower odds of hospitalization (p < .0001), 2.7 fewer international normalized ratio (INR) tests per-patient-per-month (PPPM; p < .001), and 2.3 fewer pathology/laboratory encounters PPPM (p < .0001) than warfarin patients. All-cause healthcare costs were $2638 lower with rivaroxaban versus warfarin (p < .0001) during the index SNF stay, with lower medical costs (p < .0001) but higher pharmacy costs (p < .0001). Total all-cause healthcare costs 100 days post-index SNF were $8746 lower with rivaroxaban versus warfarin (p < .0001).
Conclusions
In the SNF setting, AF patients treated with rivaroxaban had 5-day shorter length of stay, lower HRU, and lower all-cause total and medical costs compared to warfarin, despite higher treatment costs. These findings may help inform clinical decision-making to reduce economic burden.
Transparency
Declaration of funding
This study was funded by Janssen Scientific Affairs, LLC (Titusville, NJ, USA). The sponsor was involved in the study design, the collection and analysis of data, and the drafting of the manuscript.
Declaration of financial/other relationships
VSM and D. Mahajan have nothing to disclose. BW, JS, D. Milentijevic, and VA are full-time employees of Janssen Scientific Affairs, LLC. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work but have no other relevant financial relationships to disclose.
Author contributions
All authors participated in the design and analytical approach of the study and contributed to the manuscript development. Results were summarized and interpreted in collaboration with all authors. Authors vouch for the accuracy and completeness of the data reported and the adherence of the study to the protocol. All authors gave final approval of the version to be published.
Acknowledgements
Medical writing support was provided by Michelle McDermott, PharmD, of MedErgy (Yardley, PA, USA), and was funded by Janssen Scientific Affairs, LLC.
Data availability statement
The data that support the findings of this study are available from Optum but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of Optum.