Healthcare resource utilization and costs among nonvalvular atrial fibrillation patients initiating rivaroxaban or warfarin in skilled nursing facilities: a retrospective cohort study

Abstract

Objective: Atrial fibrillation (AF) is present in up to 17% of patients in skilled nursing facilities (SNFs). This study compared healthcare resource utilization (HRU) and costs between AF patients initiating rivaroxaban or warfarin in SNFs. Methods: Using de-identified claims from Optum Clinformatics Extended Data Mart (1 January 2013 to 31 December 2017), this retrospective cohort study indexed AF patients with first SNF admission during which rivaroxaban or warfarin was initiated within 3 days of admission. To adjust for selection bias, inverse probability of treatment weighting (IPTW) was applied for baseline characteristics. Logistic regression and generalized linear models were used to compare HRU and costs. Results: 519 rivaroxaban and 1129 warfarin patients met inclusion criteria. After IPTW, the cohorts were well balanced for baseline characteristics. The average length of index SNF stay was 32.07 and 37.44 days for rivaroxaban and warfarin patients, respectively. During SNF stay, rivaroxaban patients had 27% lower odds of hospitalization (p < .0001), 2.7 fewer international normalized ratio (INR) tests per-patient-per-month (PPPM; p < .001), and 2.3 fewer pathology/laboratory encounters PPPM (p < .0001) than warfarin patients. All-cause healthcare costs were $2638 lower with rivaroxaban versus warfarin (p < .0001) during the index SNF stay, with lower medical costs (p < .0001) but higher pharmacy costs (p < .0001). Total all-cause healthcare costs 100 days post-index SNF were $8746 lower with rivaroxaban versus warfarin (p < .0001). Conclusions: In the SNF setting, AF patients treated with rivaroxaban had 5-day shorter length of stay, lower HRU, and lower all-cause total and medical costs compared to warfarin, despite higher treatment costs. These findings may help inform clinical decision-making to reduce economic burden. ARTICLE HISTORY

Economic burden of rivaroxaban and warfarin among nonvalvular atrial fibrillation patients with obesity and polypharmacy

“…The economic advantage of rivaroxaban over warfarin in the present study may stem from different factors, including the lack of requirement for routine anticoagulation monitoring and fewer drug-drug interactions [48,49]. Although routine INR and other laboratory tests were not parsed out in the present analysis, significantly lower rates of all-cause and NVAF-related OP visits among rivaroxaban-treated patients may partly reflect a reduced frequency of visits related to these procedures.…”

“…Moreover, hospitalizations rates and associated costs in AF have been significantly increasing over the past two decades [42][43][44]. Evidence suggests that rivaroxaban could reduce this economic burden [45][46][47][48], including among NVAF patients with obesity [49,50] a population at high risk for multimorbidity and polypharmacy [8][9][10][11][12]. In two recent retrospective studies of NVAF patients with obesity (including one conducted by the authors of the current study), rivaroxaban was associated with significantly reduced healthcare resource utilization (HRU) and healthcare costs compared with warfarin at follow-up [49,50].…”

A Real-world Experience of the Safety and Efficacy of Non-vitamin K Oral Anticoagulants Versus Warfarin in Patients with Non-valvular Atrial Fibrillation— A Single-centre Retrospective Cohort Study in Singapore

“…Although NOACs cost more than warfarin, the healthcare resource utilisation was found to be lower for NOACs in several real-world studies. 39 The higher cost of NOACs is usually offset by the lower medical costs incurred from fewer outpatient visits (since NOACs do not necessitate INR monitoring) and lower hospitalisation rates (since NOACs contribute to better clinical outcomes), as compared to warfarin. Furthermore, a meta-analysis by Wang et al showed that the risks of ischaemic stroke, major bleeding and all-cause mortality were lower among Asians than non-Asians on standard-dose NOACs.…”

Healthcare Resource Utilization in Patients with Newly Diagnosed Atrial Fibrillation: A Global Analysis from the GARFIELD-AF Registry

“…Several studies have evaluated the multiple aspects of AF, including its HCRU burden, studied according to specific contexts, settings, or treatment options [9][10][11][12][13]. The objective of this study was to characterize the global HCRU in AF patients within the Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF).…”