Healthcare utilization and costs associated with dabigatran compared to warfarin treatment in newly diagnosed patients with non-valvular atrial fibrillation

Abstract

Purpose:

Real-world healthcare resource utilization and costs were compared among patients with non-valvular atrial fibrillation (NVAF) receiving either dabigatran or warfarin.

Methods:

A retrospective cohort study was conducted using administrative claims data from the United States Department of Defense (DOD) Military Health System. Patients with newly diagnosed AF initiated on dabigatran or warfarin were identified using ICD-9 diagnosis, procedure and drug codes. Patients were observed for 3 months prior to treatment initiation to ascertain a diagnosis of valvular heart disease and 12 months for exclusion of those with a history of anticoagulation therapy. Propensity score matching was used to balance baseline characteristics between the two treatment cohorts. Medical and pharmacy utilization and costs were compared between the dabigatran and warfarin treatment groups for 3 and 12 months following treatment initiation.

Results:

A total of 1102 patients with newly diagnosed NVAF initiated on dabigatran were matched with corresponding warfarin-treated patients. In the 12 months following initiation of anticoagulation, the mean medical costs for patients initiated on dabigatran were significantly lower than for patients initiated on warfarin (−$6299, p < 0.001), largely due to fewer hospitalizations (−0.162, p = 0.009). While pharmacy costs were higher ($4369, p < 0.001) for dabigatran, overall healthcare costs were significantly lower compared with patients on warfarin (12 months: −$1940, p < 0.001). Mean hospital length of stay between these two groups were similar (6.033 days for dabigatran vs 6.318 days for warfarin, p = 0.139).

Conclusion:

Despite higher pharmacy costs for NVAF patients initiated on dabigatran vs warfarin, this was more than offset by lower utilization of medical care resources.

Keywords: :

• Atrial fibrillation
• Costs
• Dabigatran
• Warfarin

Transparency

Declaration of funding

This study was funded by Boehringer Ingelheim Pharmaceuticals Inc.

Author contributions: All authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE), were fully responsible for all content and editorial decisions, and were involved at all stages of manuscript development.

Declaration of financial/other relationships

K.F., Y.R., and H.S. have disclosed that they are employees of Trinity Partners, a company that received funding from Boehringer Ingelheim to help conduct this study. C.Y. and H.A. have disclosed that they were employees at Trinity Partners during the conduct of the study. S.S. and S.G. have disclosed that they are employees of Boehringer Ingelheim Pharmaceuticals Inc. D.M. has disclosed that he is a paid consultant to Boehringer Ingelheim.

CMRO peer reviewer 1 has disclosed that he has received sponsorship from Boehringer Ingelheim, Bayer, Pfizer and Bristol Meyers Squibb. CMRO peer reviewers 2 and 3 have no relevant financial or other relationships to disclose.

Acknowledgments

The analyses on which this publication was based were performed with data obtained from the US Department of Defense. The authors thank Dr. Sally Tamayo from the US DoD for her contributions to this work. DoD reviewed and approved the use of its data for this work. In addition, the authors thank Dr. Valentina Zubek and Emily O’Connor from Trinity Partners for their contributions to this work.