Real-world comparison of all-cause hospitalizations, hospitalizations due to stroke and major bleeding, and costs for non-valvular atrial fibrillation patients prescribed oral anticoagulants in a US health plan

Figures & data

Table 1. Baseline characteristics in propensity score matched cohorts.

	Apixaban cohort (n = 8,328)		Warfarin cohort (n = 8,328)		Apixaban cohort (n = 3,557)		Dabigatran cohort (n = 3,557)		Apixaban cohort (n = 8,440)		Rivaroxaban cohort (n = 8,440)
	n/Mean	%/SD	n/Mean	%/SD	n/Mean	%/SD	n/Mean	%/SD	n/Mean	%/SD	n/Mean	%/SD
Age	73.54	10.72	73.37	10.42	70.92	11.41	70.68	11.19	72.84	11.06	72.53	10.79
18–54	420	5.04%	422	5.07%	303	8.52%	302	8.49%	528	6.26%	501	5.94%
55–64	1,203	14.45%	1,233	14.81%	677	19.03%	654	18.39%	1,326	15.71%	1,362	16.14%
65–74	2,556	30.69%	2,546	30.57%	1,196	33.62%	1,186	33.34%	2,585	30.63%	2,583	30.60%
≥75	4,149	49.82%	4,127	49.56%	1,381	38.82%	1,415	39.78%	4,001	47.41%	3,994	47.32%
Gender
Male	4,571	54.89%	4,531	54.41%	2,171	61.03%	2,179	61.26%	4,734	56.09%	4,740	56.16%
Female	3,757	45.11%	3,797	45.59%	1,386	38.97%	1,378	38.74%	3,706	43.91%	3,700	43.84%
US geographic region
Northeast	969	11.64%	970	11.65%	476	13.38%	495	13.92%	966	11.45%	975	11.55%
North central	1,826	21.93%	1,845	22.15%	768	21.59%	766	21.54%	1,797	21.29%	1,832	21.71%
South	3,016	36.22%	3,023	36.30%	1,332	37.45%	1,304	36.66%	3,208	38.01%	3,180	37.68%
West	2,481	29.79%	2,448	29.39%	964	27.10%	972	27.33%	2,436	28.86%	2,421	28.68%
Other	36	0.43%	42	0.50%	17	0.48%	20	0.56%	33	0.39%	32	0.38%
Insurance type
Medicare advantage	5,867	71.22%	6,342	76.15%	2,211	62.16%	2,268	63.76%	5,755	68.19%	5,714	67.70%
Commercial	2,446	29.37%	1,974	23.70%	1,335	37.53%	1,279	35.96%	2,670	31.64%	2,719	32.22%
Dosage
Standard	6,647	79.82%			2,995	84.20%			6,820	80.81%
Reduced	1,681	20.18%			562	15.80%			1,620	19.19%$
Baseline comorbidity
Baseline Deyo-Charlson comorbidity index score	2.37	2.33	2.36	2.33	2.01	2.16	2.03	2.13	2.26	2.29	2.25	2.27
Baseline CHADS2 score	2.37	1.37	2.34	1.35	2.13	1.33	2.16	1.34	2.30	1.36	2.28	1.34
0 = low risk	532	6.39%	558	6.70%	314	8.83%	305	8.57%	584	6.92%	583	6.91%
1 = moderate risk	1,811	21.75%	1,732	20.80%	943	26.51%	910	25.58%	1,960	23.22%	1,937	22.95%
2 = high risk	2,534	30.43%	2,702	32.44%	1,040	29.24%	1,085	30.50%	2,565	30.39%	2,673	31.67%
>2 = high risk	3,451	41.44%	3,336	40.06%	1,260	35.42%	1,257	35.34%	3,331	39.47%	3,247	38.47%
Baseline CHA2DS2-VASc score	3.91	1.83	3.89	1.82	3.49	1.84	3.52	1.84	3.79	1.83	3.77	1.83
0 = low risk	212	2.55%	215	2.58%	155	4.36%	152	4.27%	240	2.84%	240	2.84%
1 = moderate risk	566	6.80%	582	6.99%	395	11.10%	366	10.29%	668	7.91%	678	8.03%
2 = high risk	1,099	13.20%	1,100	13.21%	538	15.13%	564	15.86%	1,199	14.21%	1,212	14.36%
>2 = high risk	6,451	77.46%	6,431	77.22%	2,469	69.41%	2,475	69.58%	6,333	75.04%	6,310	74.76%
HAS-BLED score	2.81	1.31	2.80	1.30	2.56	1.28	2.58	1.29	2.75	1.30	2.74	1.29
0 = low risk	241	2.89%	251	3.01%	157	4.41%	163	4.58%	276	3.27%	263	3.12%
1–2 = moderate risk	3,331	40.00%	3,336	40.06%	1,632	45.88%	1,622	45.60%	3,506	41.54%	3,549	42.05%
>2 = high risk	4,756	57.11%	4,741	56.93%	1,768	49.70%	1,772	49.82%	4,658	55.19%	4,628	54.83%
Baseline prior bleed	1,434	17.22%	1,450	17.41%	495	13.92%	524	14.73%	1,421	16.84%	1,408	16.68%
Baseline prior stroke	1,008	12.10%	1,010	12.13%	359	10.09%	348	9.78%	939	11.13%	939	11.13%
Hemodialysis	17	0.20%	65	0.78%	5	0.14%	0	0.00%	16	0.19%	6	0.07%
Thrombocytopenia	253	3.04%	269	3.23%	92	2.59%	76	2.14%	249	2.95%	218	2.58%
Congestive heart failure	2,289	27.49%	2,280	27.38%	815	22.91%	830	23.33%	2,222	26.33%	2,185	25.89%
Diabetes	2,776	33.33%	2,748	33.00%	1,171	32.92%	1,178	33.12%	2,756	32.65%	2,719	32.22%
Hypertension	7,111	85.39%	7,101	85.27%	2,994	84.17%	2,980	83.78%	7,166	84.91%	7,191	85.20%
Renal disease	2,085	25.04%	2,074	24.90%	652	18.33%	640	17.99%	1,960	23.22%	1,950	23.10%
Myocardial infraction	826	9.92%	853	10.24%	299	8.41%	295	8.29%	801	9.49%	788	9.34%
Dyspepsia or stomach discomfort	1,456	17.48%	1,512	18.16%	575	16.17%	569	16.00%	1,458	17.27%	1,429	16.93%
Peripheral vascular disease	3,849	46.22%	3,853	46.27%	1,529	42.99%	1,547	43.49%	3,836	45.45%	3,782	44.81%
Transient ischemic attack	623	7.48%	585	7.02%	230	6.47%	241	6.78%	590	6.99%	587	6.95%
Coronary artery disease	3,293	39.54%	3,284	39.43%	1,336	37.56%	1,328	37.33%	3,277	38.83%	3,244	38.44%
Baseline medication use
Angiotensin converting enzyme inhibitor	3,268	39.24%	3,260	39.15%	1,347	37.87%	1,352	38.01%	3,255	38.57%	3,231	38.28%
Amiodarone	979	11.76%	965	11.59%	386	10.85%	405	11.39%	981	11.62%	958	11.35%
Angiotensin receptor blocker	1,947	23.38%	1,950	23.41%	778	21.87%	822	23.11%	2,019	23.92%	2,022	23.96%
Beta blockers	4,979	59.79%	4,952	59.46%	2,064	58.03%	2,053	57.72%	5,080	60.19%	5,079	60.18%
H2-receptor antagonist	387	4.65%	382	4.59%	138	3.88%	158	4.44%	379	4.49%	362	4.29%
Proton pump inhibitor	2,285	27.44%	2,343	28.13%	879	24.71%	899	25.27%	2,306	27.32%	2,298	27.23%
Anti-platelets	1,218	14.63%	1,188	14.27%	463	13.02%	466	13.10%	1,227	14.54%	1,235	14.63%
Statins	4,826	57.95%	4,834	58.05%	1,882	52.91%	1,884	52.97%	4,840	57.35%	4,880	57.82%
Inpatient admission	3,668	44.04%	3,679	44.18%	1,377	38.71%	1,421	39.95%	3,649	43.23%	3,618	42.87%

Table 2. Comparisons of all-cause healthcare costs, all-cause medical, pharmacy, hospitalization, and ER/outpatient medical costs after propensity score matching.

All-cause costs PPPM	Apixaban cohort (n = 8,328)	Warfarin cohort (n = 8,328)		Apixaban cohort (n = 3,557)	Dabigatran cohort (n = 3,557)		Apixaban cohort (n = 8,440)	Rivaroxaban cohort (n = 8,440)
	Marginal effect	Marginal effect	p-value	Marginal effect	Marginal effect	p-value	Marginal effect	Marginal effect	p-value
ER/outpatient medical costs	$1,935	$2,312	.014	$1,928	$1,875	.775	$1,948	$1,948	.999
Hospitalization medical costs	$1,010	$1,531	<.001	$1,031	$1,102	.705	$999	$1,237	.044
Medical costs	$2,945	$3,843	<.001	$2,958	$2,977	.942	$2,947	$3,185	.184
Pharmacy costs	$463	$318	<.001	$440	$416	.125	$460	$436	.082
Health care costs	$3,408	$4,161	<.001	$3,399	$3,394	.985	$3,407	$3,621	.235

* All-cause medical costs include all-cause ER/outpatient and hospitalization medical costs; all-cause healthcare costs include all-cause medical and pharmacy costs.

Figure 1. Patient selection criteria.

Figure 2. Propensity score matched incidence rates and hazard ratios for all-cause hospitalization among apixaban patients matched to warfarin, dabigatran, and rivaroxaban patients.

Figure 3. Propensity score matched incidence rates and hazard ratios for hospitalization due to stroke/SE among apixaban patients matched to warfarin, dabigatran, and rivaroxaban patients.

Figure 4. Propensity score matched incidence rates and hazard ratios for hospitalization due to major bleeding among apixaban patients matched to warfarin, dabigatran, and rivaroxaban patients.

Figure 5. Comparisons of stroke/SE- and major bleeding-related medical costs after propensity score matching.