Jay M Margolis1, Steven Deitelzweig2, Jeffrey Kline3, Oth Tran4, David M Smith4, Concetta Crivera5, Brahim Bookhart5, Jeff Schein5. 1. Truven Health Analytics, Bala Cynwyd, Pennsylvania. Electronic address: jay.margolis@truvenhealth.com. 2. Ochsner Health System and The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana. 3. Carolinas Medical Center, Indianapolis, Indiana. 4. Truven Health Analytics, Bethesda, Maryland. 5. Janssen Scientific Affairs LLC, Raritan, New Jersey.
Abstract
PURPOSE: Using real-world data, this study compares inpatient length of stay (LOS) and costs for patients with a primary diagnosis of pulmonary embolism (PE) initiating treatment with oral anticoagulation with rivaroxaban versus warfarin. METHODS: Hospitalizations from MarketScan's Hospital Drug Database were selected from November 1, 2012, through December 31, 2013, for adults with a primary diagnosis of PE initiating treatment with rivaroxaban or warfarin. Warfarin patients were matched 1:1 to rivaroxaban patients using exact and propensity score matching. Hospital LOS, treatment patterns, and hospitalization costs were evaluated. FINDINGS: Matched cohorts included 751 rivaroxaban-treated patients and 751 warfarin-treated patients. Adjusted mean LOS was 3.77 days for rivaroxaban patients (95% CI, 3.66-3.87 days) and 5.48 days for warfarin patients (95% CI, 5.33-5.63 days; P < .001). Mean (SD) LOS was shorter for patients taking rivaroxaban whether admission was for provoked PE (rivaroxaban: 5.2 [5.1] days; warfarin: 7.0 [6.5] days; P < .001) or unprovoked PE (rivaroxaban: 3.4 [2.3] days; warfarin: 5.1 [2.7] days; P < .001). Mean (SD) days from first dose to discharge were 2.5 (1.7) (rivaroxaban) and 4.0 (2.9) (warfarin) when initiated with parenteral anticoagulants (P < .001) and 2.7 (1.7) (rivaroxaban) and 4.0 (2.2) (warfarin) without parenteral anticoagulants (P < .001). The rivaroxaban cohort incurred significantly lower unadjusted mean (SD) hospitalization costs (rivaroxaban: $8473 [$9105]; warfarin: $10,291 [$9185]; P < .001), confirmed by covariate adjustment with generalized linear modeling estimating predicted mean hospitalization costs of $8266 for rivaroxaban patients (95% CI, $7851-$8681) and $10,511 for warfarin patients (95% CI, $10,031-$10,992; P < .001). IMPLICATIONS: patients with PE treated with rivaroxaban incurred significantly lower hospitalization costs by $2245 per admission compared with patients treated with warfarin, which was attributable to cost offsets from 1.71 fewer days of stay in the hospital.
PURPOSE: Using real-world data, this study compares inpatient length of stay (LOS) and costs for patients with a primary diagnosis of pulmonary embolism (PE) initiating treatment with oral anticoagulation with rivaroxaban versus warfarin. METHODS: Hospitalizations from MarketScan's Hospital Drug Database were selected from November 1, 2012, through December 31, 2013, for adults with a primary diagnosis of PE initiating treatment with rivaroxaban or warfarin. Warfarinpatients were matched 1:1 to rivaroxabanpatients using exact and propensity score matching. Hospital LOS, treatment patterns, and hospitalization costs were evaluated. FINDINGS: Matched cohorts included 751 rivaroxaban-treated patients and 751 warfarin-treated patients. Adjusted mean LOS was 3.77 days for rivaroxabanpatients (95% CI, 3.66-3.87 days) and 5.48 days for warfarinpatients (95% CI, 5.33-5.63 days; P < .001). Mean (SD) LOS was shorter for patients taking rivaroxaban whether admission was for provoked PE (rivaroxaban: 5.2 [5.1] days; warfarin: 7.0 [6.5] days; P < .001) or unprovoked PE (rivaroxaban: 3.4 [2.3] days; warfarin: 5.1 [2.7] days; P < .001). Mean (SD) days from first dose to discharge were 2.5 (1.7) (rivaroxaban) and 4.0 (2.9) (warfarin) when initiated with parenteral anticoagulants (P < .001) and 2.7 (1.7) (rivaroxaban) and 4.0 (2.2) (warfarin) without parenteral anticoagulants (P < .001). The rivaroxaban cohort incurred significantly lower unadjusted mean (SD) hospitalization costs (rivaroxaban: $8473 [$9105]; warfarin: $10,291 [$9185]; P < .001), confirmed by covariate adjustment with generalized linear modeling estimating predicted mean hospitalization costs of $8266 for rivaroxabanpatients (95% CI, $7851-$8681) and $10,511 for warfarinpatients (95% CI, $10,031-$10,992; P < .001). IMPLICATIONS: patients with PE treated with rivaroxaban incurred significantly lower hospitalization costs by $2245 per admission compared with patients treated with warfarin, which was attributable to cost offsets from 1.71 fewer days of stay in the hospital.
Authors: W Frank Peacock; Craig I Coleman; Phil Wells; Gregory J Fermann; Li Wang; Onur Baser; Jeff Schein; Concetta Crivera Journal: J Health Econ Outcomes Res Date: 2019-10-02
Authors: Jeffrey Trocio; Virginia M Rosen; Anu Gupta; Oluwaseyi Dina; Lien Vo; Patrick Hlavacek; Lisa Rosenblatt Journal: Clinicoecon Outcomes Res Date: 2018-12-19
Authors: Steven Deitelzweig; Jennifer D Guo; Patrick Hlavacek; Jay Lin; Gail Wygant; Lisa Rosenblatt; Anu Gupta; Xianying Pan; Jack Mardekian; Melissa Lingohr-Smith; Brandy Menges; Alexander Marshall; Anagha Nadkarni Journal: Clin Appl Thromb Hemost Date: 2018-11-15 Impact factor: 2.389
Authors: Thomas L Ortel; Ignacio Neumann; Walter Ageno; Rebecca Beyth; Nathan P Clark; Adam Cuker; Barbara A Hutten; Michael R Jaff; Veena Manja; Sam Schulman; Caitlin Thurston; Suresh Vedantham; Peter Verhamme; Daniel M Witt; Ivan D Florez; Ariel Izcovich; Robby Nieuwlaat; Stephanie Ross; Holger J Schünemann; Wojtek Wiercioch; Yuan Zhang; Yuqing Zhang Journal: Blood Adv Date: 2020-10-13
Authors: Jeffrey Kline; David Adler; Naomi Alanis; Joseph Bledsoe; Daniel Courtney; James D'Etienne; Deborah B Diercks; John Garrett; Alan E Jones; David MacKenzie; Troy Madsen; Andrew Matuskowitz; Bryn Mumma; Kristen Nordenholz; Justine Pagenhardt; Michael Runyon; William Stubblefield; Christopher Willoughby Journal: BMJ Open Date: 2020-10-01 Impact factor: 2.692