EINSTEIN-PE: Rivaroxaban associated with cost savings, reduced LOS

Treatment of pulmonary embolism with rivaroxaban was associated with cost savings of more than $2,000 per patient compared with treatment with enoxaparin plus warfarin, according to new findings from the EINSTEIN-PE study.

The researchers found that patients with pulmonary embolism (PE) assigned the oral anticoagulant rivaroxaban (Xarelto, Janssen Pharmaceuticals) spent one less day in the hospital on average than patients with PE assigned enoxaparin (Lovenox, Sanofi-Aventis) plus warfarin, resulting in an estimated savings of $2,040 per patient, Brahim Bookhart, MBA, MPH, said during a presentation at the American College of Emergency Physicians scientific assembly.

The researchers conducted an economic analysis of the North American cohort of the EINSTEIN-PE trial (244 patients assigned enoxaparin; 242 assigned enoxaparin plus warfarin). Rates of hospitalization were similar (rivaroxaban group, 66.8%; enoxaparin plus warfarin group, 66.6%).

Randomization to rivaroxaban was associated with a hospital length of stay (LOS) reduction of 1 day compared with randomization to enoxaparin plus warfarin (P=.0002). The median LOS was 3 days for the rivaroxaban group (interquartile range, 3-5) vs. 4 days for the enoxaparin plus warfarin group (interquartile range, 3-6), said Bookhart, director of health economics and outcomes research at Janssen Scientific Affairs. Analysis via exponentiated least squares mean of a log-transformed LOS produced the same 1-day LOS reduction (rivaroxaban group, 4.2 days; enoxaparin plus warfarin group, 5.2 days; P=.0013).

To calculate cost savings, the researchers used data from the Healthcare Cost and Utilization Project, which indicated that the average cost per day for in-hospital PE treatment is $2,040, Bookhart said.

The findings were consistent with a previous analysis of the entire EINSTEIN-PE cohort (n=4,833), which also found a median LOS difference of 1 day (rivaroxaban group, 6 days (interquartile range, 4-9); enoxaparin plus warfarin group, 7 days (interquartile range, 5-10), Bookhart said.

For more information:

Bookhart B. Research Forum. Presented at: the American College of Emergency Physicians scientific assembly; Oct. 14-17, 2013; Seattle.

Disclosure: Bookhart is employed by Janssen Scientific Affairs and owns stock in parent company Johnson & Johnson.