Rivaroxaban linked to less hospitalization, similar total costs vs. warfarin

CHICAGO — Rivaroxaban was associated with significantly fewer total hospitalization days, fewer outpatient visits and fewer atrial fibrillation-related hospitalizations, according to an analysis presented at the American Heart Association Scientific Sessions.

Researchers also found that even when including medication costs, overall all-cause and nonvalvular AF-related costs were comparable between rivaroxaban and warfarin, and that hospitalization and outpatient costs were lower for rivaroxaban vs. warfarin for patients with nonvalvular AF.

Researchers assessed the effect of rivaroxaban (Xarelto, Janssen Pharmaceuticals) vs. warfarin on the total number of hospitalization days, health care resource utilization and costs in patients with nonvalvular AF (mean age, 74 years; 46% women). They analyzed de-identified health insurance claims from the Humana database between May 2011 and December 2012.

“This study is showing that there are misconceptions,” Concetta Crivera, PharmD, MPH, director of HECOR Cardiovascular, Janssen Scientific Affairs, told Cardiology Today. “Even though warfarin is costing pennies a day, when we look at the entire cost of care, we see a huge hospital offset, and the [overall] costs are comparable between the two groups.”

Concetta Crivera

All patients analyzed were newly prescribed rivaroxaban or warfarin after November 2011 and had at least two AF diagnoses during baseline or follow-up.

Crivera and colleagues performed a 1:1 propensity match between users of rivaroxaban (n=2,253) and warfarin (n=2,253). They compared total number of hospital days; hospitalizations, ED visits and outpatient visits for any cause; and hospitalizations, ED visits and outpatient visits related to AF. They also compared costs for all-cause and AF-related resource use, including hospitalizations, ED visits, outpatient visits and pharmacy. Data related to monitoring of warfarin were included in outpatient visits, Crivera said.

Patients using rivaroxaban had a lower total number of hospitalization days compared with those using warfarin, both for any cause (rivaroxaban group, 2.71 days; warfarin group, 3.87 days; difference, 1.16; 95% CI, 0.08-2.15) and AF related (rivaroxaban group, 2.11 days; warfarin group, 3.02 days; difference, 0.91; 95% CI, 0.13-1.72).

In measures of health care resource utilization, mean hospitalizations (all-cause: rivaroxaban group, 0.55; warfarin group, 0.73; difference, –0.18; 95% CI, –0.4 to 0.03; AF-related: rivaroxaban group, 0.4; warfarin group, 0.57; difference, –0.17; 95% CI, –0.34 to –0.03) and mean outpatient visits (all-cause: rivaroxaban group, 25.3; warfarin group, 35.8; difference, –10.5; 95% CI, –13.6 to –7.3; AF-related: rivaroxaban group, 5,48; warfarin group, 9.06; difference, –3.59; 95% CI, –5.15 to –1.98) favored the rivaroxaban group. However, mean ED visits (all-cause: rivaroxaban group, 0.92; warfarin group, 0.72; difference, 0.19; 95% CI, –0.04 to 0.45; AF-related: rivaroxaban group, 0.48; warfarin group, 0.26; difference, 0.23; 95% CI, 0.05-0.43) favored the warfarin group, according to the researchers.

Possible explanations for the lower outpatient visits associated with rivaroxaban include that “rivaroxaban is more convenient; there is no monitoring associated with it and fewer drug-drug interactions” compared with warfarin, Crivera said.

Total costs were comparable between the groups, both for all-cause (rivaroxaban group, $17,590; warfarin group, $18,676; mean difference, –$1,086; P=.5418) and AF related (rivaroxaban group, $7,394; warfarin group, $7,319; mean difference, $74; P=.9431). Pharmacy costs were higher for the rivaroxaban group (P<.0001 for all-cause and AF-related), but hospitalization costs were lower (P=.0468 for all-cause; P=.0201 for AF-related), according to the researchers.

“With the rising costs of health care for payers and patients, we need to take a more holistic approach,” Crivera said. “We need to not only focus on that warfarin costs pennies, but consider health care resource utilization measures as a whole. Hospitalization is making the costs comparable between the two groups.” – by Erik Swain

For more information:

Crivera C. Treatment of arrhythmias: pharmacological — novel anticoagulants. Presented at: American Heart Association Scientific Sessions; Nov. 15-19, 2014; Chicago.

Disclosure: The study was supported by Janssen Scientific Affairs. Crivera is an employee of and owns stock in Johnson & Johnson.