Costs of hospital visits among patients with deep vein thrombosis treated with rivaroxaban and LMWH/warfarin

Abstract

Background

For many years, the standard of care for patients diagnosed with deep vein thrombosis (DVT) has been low-molecular-weight heparin (LMWH) bridging to an oral Vitamin-K antagonist (VKA). The availability of new non-VKA oral anticoagulants (NOAC) agents as monotherapy may reduce the likelihood of hospitalization for DVT patients.

Objective

To compare hospital visit costs of DVT patients treated with rivaroxaban and LMWH/warfarin.

Methods

A retrospective claim analysis was conducted using the MarketScan Hospital Drug Database for care provided between January 2011 and December 2013. Adult patients using rivaroxaban or LMWH/warfarin with a primary diagnosis of DVT during the first day of a hospital visit were identified (i.e., index hospital visit). Based on propensity-score methods, historical LMWH/warfarin patients (i.e., patients who received LMWH/warfarin before the approval of rivaroxaban) were matched 4:1 to rivaroxaban patients. The hospital-visit cost difference between these groups was evaluated for the index hospital visit, as well as for total hospital-visit costs (i.e., including index and subsequent hospital visit costs).

Results

All rivaroxaban users (n = 134) in the database were well-matched with four LMWH/warfarin users (n = 536). The mean hospital-visit costs were $5257 for the rivaroxaban cohort and $6764 in the matched-cohort of patients using LMWH/warfarin. The $1508 cost difference was statistically significant between cohorts (95% CI = [−$2296; −$580]; p-value = 0.002). Total hospital-visit costs were lower for rivaroxaban compared to LMWH/warfarin users within 1, 2, 3, and 6 months after index visit (significantly lower within 1 and 3 months, p-values <0.05)

Limitations

Limitations were inherent to administrative-claims data, completeness of baseline characteristics, adjustments restricted to observational factors, and lastly the sample size of the rivaroxaban cohort.

Conclusion

The availability of rivaroxaban significantly reduced the costs of hospital visits in patients with DVT treated with rivaroxaban compared to LMWH/warfarin.

Keywords::

• Deep vein thrombosis
• Non-vitamin-K antagonist oral anticoagulant
• Hospitalization
• Costs

Transparency

Declaration of funding

This research was funded by Janssen Scientific Affairs, LLC, Raritan, NJ.

Declaration of financial/other relationship

GJM and JEH have received consulting fees from Janssen Scientific Affairs. MKR and BB are employees of Janssen Scientific Affairs. PL, FL, and GG are employees of Analysis Group, Inc., a consulting company that has received research grants from Janssen Scientific Affairs. CVP reports receiving consulting fees for scientific activities from Janssen, Boehringer-Ingelheim, Pfizer, and Daiichi-Sankyo. CVP and JEH have engaged in no promotional activities.

Acknowledgments

The authors would like to acknowledge Jeff R. Schein, Janssen Scientific Affairs, LLC, Raritan, NJ, who provided assistance during the study.