Healthcare costs associated with rivaroxaban or warfarin use for the treatment of venous thromboembolism

Abstract

Introduction: Rivaroxaban has been shown to have similar efficacy but less major bleeding than warfarin in randomized trials of patients experiencing venous thromboembolism (VTE). This report sought to assess healthcare costs up to 12-months following an index VTE in patients prescribed either rivaroxaban or warfarin.

Materials and methods: This study analyzed claims from the MarketScan Commercial Claims and Encounters Database from November 2011–July 2015. It selected adults newly-diagnosed with VTE (deep vein thrombosis [DVT] or pulmonary embolism [PE]) if they had an outpatient prescription claim for rivaroxaban or warfarin within 7-days of the index event. Warfarin users were 2:1 propensity-score matched to rivaroxaban users and followed until the end of insurance coverage, end of data availability or 12-months of follow-up. Total per patient healthcare costs, including inpatient, outpatient, and overall pharmacy costs, were compared using a multivariable generalized linear model.

Results: In total, 10,929 rivaroxaban patients were matched to 21,858 warfarin patients. Mean follow-up for rivaroxaban and warfarin patients was 317- and 321-days for those experiencing an index DVT, and 313- and 318-days for those with PE. Mean overall treatment costs per patient were lower for rivaroxaban vs warfarin users (−$1,116, p = .0016). This cost difference was driven by lower inpatient (−$622) and outpatient (−$1,156) treatment costs, and the higher pharmacy costs ($661) were, therefore, fully offset. Results were similar when analysis was restricted to DVT patients. No significant difference in total costs was observed in patients experiencing an index PE.

Limitations: Claims databases are subject to inaccuracies and missing data. Prescription claims may not fully reflect actual medication utilization. Despite propensity-score matching and regression, residual confounding cannot be excluded.

Conclusions: Rivaroxaban was associated with significantly lower total per patient VTE treatment costs, despite higher pharmacy costs. These savings are the result of decreased inpatient and outpatient healthcare utilization costs associated with rivaroxaban.

Keywords:

• Healthcare costs
• venous thromboembolism
• rivaroxaban
• warfarin
• deep vein thrombosis
• pulmonary embolism

Transparency

Declaration of funding

This study was funded by Janssen Scientific Affairs, LLLC, Raritan, NJ.

Declaration of financial/other interests

CIC has received research grant funding or honorarium from Janssen Scientific Affairs, LLC, Bayer Pharma AG, Boehringer Ingelheim Pharmaceuticals. CB is a Roche Diagnostics Advisory Board member and received consulting fees from Janssen Pharmaceuticals. He also reports research support from Janssen Pharmaceuticals and Boehringer Ingelheim. CC, DM, SWW, and LL are employees of Janssen Scientific Affairs, LLC, and WWN was an employee of Janssen Scientific Affairs, LLC at the timing the research was conducted. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Table 1. Characteristics of propensity-score matched rivaroxaban and warfarin patients experiencing an index deep vein thrombosis of pulmonary embolism.

Table 2. Cumulative 12-month per patient post-venous thromboembolism costs.

Table 3. Cumulative 12-month per patient post-deep vein thrombosis costs.

Table 4. Cumulative 12-month per patient post-pulmonary embolism costs.