Yan Xu1, Sam Schulman2, Dar Dowlatshahi3, Anne M Holbrook4, Christopher S Simpson5, Lois E Shepherd6, Philip S Wells3, Antonio Giulivi7, Tara Gomes8, Muhammad Mamdani9, Eliot Frymire10, Shahriar Khan10, Ana P Johnson11. 1. Department of Medicine, University of Toronto, Toronto, Canada. 2. Department of Medicine, McMaster University, Hamilton, Canada. 3. Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada. 4. Department of Medicine, McMaster University, Hamilton, Canada; Division of Clinical Pharmacology & Toxicology, McMaster University, St. Joseph's Hospital, Hamilton, Canada. 5. Department of Medicine, Queen's University, Kingston, Canada. 6. Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada. 7. Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada. 8. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. 9. Institute for Clinical Evaluative Sciences, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada. 10. Health Services and Policy Research Institute, Queen's University, Kingston, Canada. 11. Health Services and Policy Research Institute, Queen's University, Kingston, Canada; Department of Public Health Sciences, Queen's University, Kingston, Canada. Electronic address: ana.johnson@queensu.ca.
Abstract
INTRODUCTION: Direct oral anticoagulants (DOACs) have expanded the options for antithrombotic therapy. DOAC-related major bleeds are associated with favorable outcomes compared to warfarin in clinical trials and routine practice. However, it is unclear whether management of DOAC-associated major bleeding incurs higher resource utilization and costs. MATERIALS AND METHODS: We screened medical records of patients ≥ 66 years with atrial fibrillation admitted to one of five tertiary care hospitals in Ontario, Canada with a hemorrhage. We abstracted bleeds involving DOACs or warfarin and linked them to administrative databases to capture length of hospital stay, blood product use, procedural interventions, intensive care unit (ICU) utilization and related direct medical costs. To control for confounders, multivariate logistic and linear regressions were used for binary and linear outcomes respectively. RESULTS: Among 19,061 records screened, 1978 (10.4%) cases involving 1632 patients met criteria of oral anticoagulant-associated bleeding. Baseline characteristics between DOAC and warfarin groups were similar. Blood product costs were higher for DOACs (all comparisons DOACs vs. warfarin, $1456 vs. $1109, mean difference $347, 95% CI $185 to $509), but length of stay and ICU use were similar. Mean direct medical costs did not differ ($9217 vs. $10,790, adjusted relative ratio 0.94, 95% CI 0.84-1.05). CONCLUSIONS: Prior to introduction of DOAC-specific reversal agents, resource utilization and medical costs were comparable between DOAC- and warfarin-associated major bleeds, despite marginally higher blood product costs incurred by the former. Resource intensity associated with anticoagulant-related bleeding remains high, and our data provide measures for cost-effectiveness evaluation of emerging DOAC antidotes.
INTRODUCTION: Direct oral anticoagulants (DOACs) have expanded the options for antithrombotic therapy. DOAC-related major bleeds are associated with favorable outcomes compared to warfarin in clinical trials and routine practice. However, it is unclear whether management of DOAC-associated major bleeding incurs higher resource utilization and costs. MATERIALS AND METHODS: We screened medical records of patients ≥ 66 years with atrial fibrillation admitted to one of five tertiary care hospitals in Ontario, Canada with a hemorrhage. We abstracted bleeds involving DOACs or warfarin and linked them to administrative databases to capture length of hospital stay, blood product use, procedural interventions, intensive care unit (ICU) utilization and related direct medical costs. To control for confounders, multivariate logistic and linear regressions were used for binary and linear outcomes respectively. RESULTS: Among 19,061 records screened, 1978 (10.4%) cases involving 1632 patients met criteria of oral anticoagulant-associated bleeding. Baseline characteristics between DOAC and warfarin groups were similar. Blood product costs were higher for DOACs (all comparisons DOACs vs. warfarin, $1456 vs. $1109, mean difference $347, 95% CI $185 to $509), but length of stay and ICU use were similar. Mean direct medical costs did not differ ($9217 vs. $10,790, adjusted relative ratio 0.94, 95% CI 0.84-1.05). CONCLUSIONS: Prior to introduction of DOAC-specific reversal agents, resource utilization and medical costs were comparable between DOAC- and warfarin-associated major bleeds, despite marginally higher blood product costs incurred by the former. Resource intensity associated with anticoagulant-related bleeding remains high, and our data provide measures for cost-effectiveness evaluation of emerging DOAC antidotes.
Authors: Tamana Meihandoest; Jan-Dirk Studt; Adriana Mendez; Lorenzo Alberio; Pierre Fontana; Walter A Wuillemin; Adrian Schmidt; Lukas Graf; Bernhard Gerber; Ursula Amstutz; Cedric Bovet; Thomas C Sauter; Lars M Asmis; Michael Nagler Journal: Front Cardiovasc Med Date: 2022-03-17
Authors: Alex C Spyropoulos; Briain O Hartaigh; Zhun Cao; Craig Lipkin; Scott B Robinson; Harjeet Caberwal; Michaela Petrini; Cheng Wang Journal: Cardiol Res Date: 2022-01-10