Comparison of stroke- and bleed-related healthcare resource utilization and costs among patients with newly diagnosed non-valvular atrial fibrillation and newly treated with dabigatran, rivaroxaban, or warfarin

ABSTRACT

Background: This is one of the first head-to-head real-world evidence studies comparing stroke-related and bleed-related healthcare and resource utilization (HCRU) and costs among non-valvular atrial fibrillation (NVAF) patients initiating oral anticoagulants.

Methods: Adult NVAF patients newly diagnosed and treated with dabigatran, rivaroxaban, or warfarin between 10/01/2010 and 12/31/2014 were identified using MarketScan Commercial and Medicare Supplemental databases. Per-patient-per-month stroke and bleed-related HCRU and costs were reported.

Results: Dabigatran patients were matched 1:1 to 26,592 rivaroxaban and 33,024 warfarin patients (mean age=68 years). Compared to rivaroxaban, dabigatran patients had lower bleed-related inpatient and outpatient HCRU (0.004 vs. 0.005; 0.099 vs. 0.145) and significantly lower adjusted bleed-related costs ($116 vs. $172), all p <0.05. Compared to warfarin, dabigatran patients had significantly lower stroke-related outpatient visits (0.034 vs. 0.048, p<0.001) and higher bleed-related outpatient visits (0.101 vs. 0.091, p=0.045). Multivariate adjusted bleed-related costs were significantly lower for dabigatran patients than warfarin patients ($94 vs. $138, p<0.001).

Conclusions: The results suggest that dabigatran patients had lower bleed-related HCRU and costs than rivaroxaban patients, and lower outpatient stroke-related HCRU, higher bleed-related outpatient HCRU, and lower bleed-related costs than warfarin patients. It provides valuable stroke-related and bleed-related HCRU and costs information among commercially insured and Medicare patients.

KEYWORDS:

• Non-valvular atrial fibrillation
• oral anticoagulants
• stroke-related healthcare utilization and costs
• bleed-related healthcare utilization and costs

Acknowledgments

Editorial/medical writing support for this manuscript was provided by Jay Margolis, PharmD (Truven Health Analytics).

Author contributions

AG: conceptualization, analysis, writing original draft, and editing; JFE: conceptualization, analysis, writing review, editing; XS: conceptualization, analysis, writing review, and editing; CW: conceptualization, analysis, writing review, editing; CH: programming, analysis, data quality review, editing; ASN: conceptualization, analysis, writing review and editing; KW: conceptualization, analysis, writing review and editing; DMS: conceptualization, statistical analysis, writing review and editing; SS: conceptualization, analysis, writing review, editing.

Declaration of Interest

AM Gilligan, X Song, C Henriques, A Sainski-Nguyen, K Wilson, and DM Smith are employees of Truven Health Analytics, an IBM Company which received compensation from Boehringer-Ingelheim Pharmaceuticals Inc., for the overall conduct of the study and preparation of this manuscript. J Franchino-Elder, C Wang, and S Sander are employees of Boehringer-Ingelheim Pharmaceuticals Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was sponsored by Boehringer Ingelheim Pharmaceuticals, Inc.