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

Amin, Alpesh; Keshishian, Allison; Vo, Lien; Zhang, Qisu; Dina, Oluwaseyi; Patel, Chad; Odell, Kevin; Trocio, Jeffrey

doi:10.1080/13696998.2017.1394866

Cited by 18 publications

(27 citation statements)

References 52 publications

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“…The remaining 196 studies underwent full-text review, and 25 of those were included in the systematic review. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][34][35][36][37][38][39][40][41]…”

Section: Search Resultsmentioning

confidence: 99%

“…Five studies used alternative exposure definitions in sensitivity analyses. [20,24,35,37,41] Among the seven studies not explicitly excluding patients with previous VKA use, [11,13,15,35,36,39,41] three accounted for it at the stage of statistical analysis, [11,13,41] while the other four did not. [15,35,36,39]…”

Section: Study Characteristicsmentioning

confidence: 99%

“…However, three studies using both as-treated and intention-totreat definitions (in sensitivity analyses) while not having other sources of selection bias were ascribed a low risk in this respect given the complementary nature of these analyses. [20,24,37] Moreover, considering the short follow-up of the included studies (<1 year) and the resulting low risk of exposure misclassification, studies using an intention-to-treat approach were ascribed a low risk of "bias in classification of interventions". Finally, 'bias in selection of reported results' due to the absence of a prespecified study protocol also affected the quality of most of the included studies (see Electronic Supplementary Material eTable 4).…”

Section: Assessment Of Risk Of Biasmentioning

confidence: 99%

“…[8,9] Moreover, numerous studies reporting head-to-head comparisons among DOACs that were recently published were not included in these earlier works. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Thus, the objective of this systematic review and meta-analysis of observational studies was to provide an up-to-date synthesis of the available real-world evidence on DOAC comparative effectiveness and safety in patients with AF, while thoroughly assessing the risk of bias of the included studies. This is a post-peer-review, pre-copyedit version of an article published in 'Drug Safety'.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Effectiveness and Safety of Direct Oral Anticoagulants in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis of Observational Studies

et al. 2019

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Background: There are no head-to-head randomized controlled trials comparing different direct oral anticoagulants (DOACs). Thus, we systematically reviewed and meta-analyzed observational studies assessing the comparative effectiveness and safety of DOACs for stroke prevention in patients with atrial fibrillation (AF). Methods:We systematically searched MEDLINE and EMBASE up to February 2019 for observational studies comparing head-to-head different DOACs in patients with AF. Two independent reviewers identified studies, extracted data, and assessed the risk of bias using the ROBINS-I tool. Random-effects models were used to meta-analyze data across higher quality studies.Results: We identified 25 cohort studies including 1,079,565 patients with AF treated with DOACs. Meta-analysis of the 19 studies at moderate risk of bias yielded a similar risk of ischemic stroke for rivaroxaban versus dabigatran (6 studies; hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.83 to 1.04; I 2 : 0%), for apixaban versus dabigatran (5 studies; HR, 0.94; 95% CI, 0.82 to 1.09; I 2 : 0%), and for apixaban versus rivaroxaban (4 studies; HR, 1.07; 95% CI, 0.93 to 1.23; I 2 : 0%). Regarding major bleeding, there was an increased risk for rivaroxaban versus dabigatran (6 studies; HR, 1.33; 95% CI, 1.20 to 1.47; I 2 : 22%) and decreased risks for apixaban versus either dabigatran (8 studies; HR, 0.71; 95% CI, 0.64 to 0.78; I 2 : 0%) or rivaroxaban (8 studies; HR, 0.56; 95% CI, 0.48 to 0.65; I 2 : 69%). Conclusions:As head-to-head trials comparing different DOACs do not exist, available evidence derives exclusively from observational studies. These data suggest that while dabigatran, rivaroxaban, and apixaban have a similar effect on the risk of ischemic stroke, apixaban may be associated with a decreased risk of major bleeding compared with either dabigatran or rivaroxaban. This is a post-peer-review, pre-copyedit version of an article published in 'Drug Safety'.

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Section: Search Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Assessment Of Risk Of Biasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparative Effectiveness and Safety of Direct Oral Anticoagulants in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis of Observational Studies

et al. 2019

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“…Several studies showed that patients initiated on DOACs incur lower healthcare costs than those initiated on warfarin [21][22][23][24] . However, studies that directly compared healthcare costs between patients treated with rivaroxaban and apixaban report mixed results [25][26][27][28] . For example, a retrospective study that included commercially-insured patients who received rivaroxaban or apixaban prior to 2015 found no significant difference in all-cause healthcare costs between patients initiated on apixaban versus rivaroxaban 25 .…”

Section: Introductionmentioning

confidence: 99%

Healthcare costs of NVAF patients treated with rivaroxaban and apixaban in the US

Milentijevic

Germain

Laliberté

et al. 2020

Journal of Medical Economics

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Objectives: To provide the most current assessment of real-world healthcare resource utilization (HRU) and costs among patients with non-valvular atrial fibrillation (NVAF) who newly initiated rivaroxaban and apixaban using a large US database. Material and methods: A retrospective weighted cohort design was used with healthcare insurance claims from the Optum Clinformatics Data Mart databases (January 2012-December 2018). The index date was defined as the first dispensing of rivaroxaban or apixaban. Adult NVAF patients with an index date on or after 1 January 2016, ! 12 months of continuous eligibility before the index date and ! 1 month after, and without prior use of oral anticoagulant were included. The observation period spanned from the index date to the earliest of the end of data availability, end of insurance coverage, or death. Inverse probability of treatment weighting (IPTW) was used to adjust for differences in baseline characteristics between cohorts. All-cause healthcare resource utilization (HRU), including hospitalization, emergency room, and outpatient visits, and healthcare costs, including medical and pharmacy costs, were evaluated from the payer's perspective during the observation period up to 18 and 24 months, separately. Results: In total, 23,822 rivaroxaban and 53,666 apixaban users were included. After weighting, all baseline characteristics were well balanced between cohorts (mean age: 73.8 years, female: 46.6% in both cohorts). Up to 18 months of follow-up, rivaroxaban users incurred significantly lower total healthcare costs compared to apixaban users (cost difference ¼ À$1,121; p ¼ 0.020), driven by significantly lower rates of outpatient hospital visits and associated costs (cost difference ¼ À$1,579; p < 0.001). Similar results were found in the analysis conducted for up to 24 months of follow-up (total cost difference ¼ -$1,111; p ¼ 0.020). Conclusions: In this large retrospective analysis, patients with NVAF initiated on rivaroxaban incurred significantly lower healthcare costs compared to those initiated on apixaban, which were primarily driven by significantly lower outpatient visits and costs during the 18-and 24-month followup periods.

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Does prescribing apixaban or rivaroxaban versus warfarin for patients diagnosed with atrial fibrillation save health system costs? A multivalued treatment effects analysis

Situ,

Schwarz,

Zou

et al. 2023

Eur J Health Econ

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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

Cited by 18 publications

References 52 publications

Comparative Effectiveness and Safety of Direct Oral Anticoagulants in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis of Observational Studies

Comparative Effectiveness and Safety of Direct Oral Anticoagulants in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis of Observational Studies

Healthcare costs of NVAF patients treated with rivaroxaban and apixaban in the US

Does prescribing apixaban or rivaroxaban versus warfarin for patients diagnosed with atrial fibrillation save health system costs? A multivalued treatment effects analysis

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