Reduction in the length of stay with rivaroxaban as a single-drug regimen for the treatment of deep vein thrombosis and pulmonary embolism

Bellen, Bonno van; Bamber, Luke; Carvalho, Francine C. de; Prins, Martin H.; Wang, Maria; Lensing, Anthonie W. A.

doi:10.1185/03007995.2013.879439

Cited by 94 publications

(83 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our study reported a larger percentage of primary PE hospitalizations (61%) compared with primary DVT (39%), which is consistent with the 2012 evidence‐based guidelines for VTE antithrombotic therapy recommending home treatment (when possible) for acute DVT and hospitalization for PE due to higher associated short‐term PE mortality 5. This is also consistent with the EINSTEIN trials in which 52% of DVT patients and 90% of PE patients were hospitalized 10. DVT patients admitted to the hospital may therefore represent a potentially higher‐risk subpopulation than those treated as outpatients.…”

Section: Discussionsupporting

confidence: 90%

“…In North American EINSTEIN patients, rivaroxaban was associated with a mean LOS of 4.5 days in hospitalized patients compared with a mean LOS of 6.1 days in warfarin‐treated patients 11. The multinational post hoc analysis of the EINSTEIN trials saw variations in hospitalization rates and LOS across regions, but, in all cases, LOS was significantly shorter in the rivaroxaban‐treated group compared with standard treatment 10. The results of the current study (3.71 days for rivaroxaban and 5.28 days for warfarin) are important in that they corroborate the findings of the clinical trials with real‐world evidence across practice settings in a large sample of US hospitals.…”

Section: Discussionmentioning

confidence: 93%

“…A post hoc analysis of the hospitalization records from the EINSTEIN clinical trials found that hospitalized patients treated with rivaroxaban had significantly shorter lengths of stay (LOSs) than those treated with enoxaparin/VKA 10. A separate analysis of the US and Canadian subset of EINSTEIN‐DVT and ‐PE patients found a 1.6‐day mean reduction in LOS for patients treated with rivaroxaban versus those treated with enoxaparin/VKA 11.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Margolis

Deitelzweig

Kline

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundVenous thromboembolism, including deep vein thrombosis and pulmonary embolism, results in a substantial healthcare system burden. This retrospective observational study compared hospital length of stay (LOS) and hospitalization costs for patients with venous thromboembolism treated with rivaroxaban versus those treated with warfarin.Methods and ResultsHospitalizations for adult patients with a primary diagnosis of deep vein thrombosis or pulmonary embolism who were initiated on rivaroxaban or warfarin were selected from MarketScan's Hospital Drug Database between November 1, 2012, and December 31, 2013. Patients treated with warfarin were matched 1:1 to patients treated with rivaroxaban using exact and propensity score matching. Hospital LOS, time from first dose to discharge, and hospitalization costs were reported descriptively and with generalized linear models (GLMs). The final study cohorts each included 1223 patients (751 with pulmonary embolism and 472 with deep vein thrombosis). Cohorts were well matched for demographic and clinical characteristics. Mean (±SD) LOS was 3.7±3.1 days for patients taking rivaroxaban and 5.2±3.7 days for patients taking warfarin, confirmed by GLM‐adjusted results (rivaroxaban 3.7 days, warfarin 5.3 days, P<0.001). Patients with provoked venous thromboembolism admissions showed longer LOSs (rivaroxaban 5.1±4.5 days, warfarin 6.5±5.6 days, P<0.001) than those with unprovoked venous thromboembolism (rivaroxaban 3.3±2.4 days, warfarin 4.8±2.8 days, P<0.001). Days from first dose to discharge were 2.4±1.7 for patients treated with rivaroxaban and 3.9±3.7 for patients treated with warfarin when initiated with parenteral anticoagulants (P<0.001), and 2.7±1.7 and 3.7±2.1, respectively, when initiated without parenteral anticoagulants (P<0.001). Patients initiated on rivaroxaban incurred significantly lower mean total hospitalization costs ($8688±$9927 versus $9823±$9319, P=0.004), confirmed by modeling (rivaroxaban $8387 [95% confidence interval, $8035–$8739]; warfarin $10 275 [95% confidence interval, $9842–$10 708]).ConclusionsRivaroxaban was associated with significantly shorter hospital LOS and lower hospitalization costs compared with warfarin.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Margolis

Deitelzweig

Kline

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…The availability of oral drugs that do not require prior parenteral drug administration is expected to increase the number of patients who can be treated directly at home, including low‐risk patients with acute PE 16. This potential shift in care is supported by evidence from EINSTEIN DVT and EINSTEIN PE, in which hospitalized patients receiving rivaroxaban had a significantly shorter length of stay compared with patients receiving enoxaparin/VKA 17. Therefore, use of oral rivaroxaban could reduce the costs and inconvenience of hospital admission and obviate the need for instructing patients on the technique for administering subcutaneous injections 18.…”

Section: Discussionmentioning

confidence: 99%

Use of Prestudy Heparin Did Not Influence the Efficacy and Safety of Rivaroxaban in Patients Treated for Symptomatic Venous Thromboem‐bolism in the EINSTEIN DVT and EINSTEIN PE Studies

Prandoni

Prins

Cohen

et al. 2015

Academic Emergency Medicine

View full text Add to dashboard Cite

ObjectivesIn the EINSTEIN DVT and EINSTEIN PE studies, the majority of patients received heparins to bridge the period during venous thromboembolism (VTE) diagnosis confirmation and the start of the study. In contrast to vitamin K antagonists (VKAs), rivaroxaban may not require initial heparin treatment.MethodsTo evaluate the effect of prestudy heparin on the efficacy and safety of rivaroxaban relative to enoxaparin/VKA, the 3‐month incidence of recurrent VTE, and the 14‐day incidence of major and nonmajor clinically relevant bleeding were compared in patients who did and did not receive prestudy heparin.ResultsOf the 8,281 patients randomized, 6,937 (83.8%) received prestudy heparin (mean ± SD duration = rivaroxaban: 1.04 [± 0.74] days; enoxaparin 1.03 [± 0.42] days), and 1,344 (16.2%) did not. In patients who did not receive prestudy heparin, the incidences of recurrent VTE were similar in rivaroxaban (15 of 649, 2.3%) and enoxaparin/VKA (13 of 695, 1.9%) patients (adjusted hazard ratio [HR] = 1.11; 95% confidence interval [CI] = 0.52 to 2.37). The incidences of recurrent VTE were also similar in rivaroxaban (54 of 3,501, 1.5%) and enoxaparin/VKA (69 of 3,436, 2.0%) patients who did receive prestudy heparin (adjusted HR = 0.74; 95% CI = 0.52 to 1.06; pinteraction = 0.32). The incidences of major or nonmajor clinically relevant bleeding with rivaroxaban were not significantly different from those with enoxaparin/VKA, either with (105 of 3,485, 3.0% vs. 104 of 3,428, 3.0%; adjusted HR = 0.98; 95% CI = 0.75 to 1.29) or without (24 of 645, 3.7% vs. 30 of 688, 4.4%; adjusted HR = 0.81; 95% CI = 0.46 to 1.40; pinteraction = 0.68) prestudy heparin.ConclusionsAlthough the majority of patients in the EINSTEIN studies received prestudy heparin, there were no notable differences in treatment effect of rivaroxaban versus enoxaparin/VKA in those who did and did not receive it.

show abstract

“…The costs of VTE recurrence included hospitalisation costs [25], costs related to diagnosis and treatment of DVT (£551) and PE (£1,647, resulting in an average cost of £1,236 per VTE recurrence. The cost of a major bleed included the hospital admission costs.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

Clay

Jamotte

Verhamme

et al. 2018

Journal of Market Access & Health Policy

View full text Add to dashboard Cite

Background: Venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), is the third most common acute cardiovascular disease and represents an important burden for patients and payers.Objective: The aim was to estimate the cost-effectiveness of edoxaban, a non-VKA oral anticoagulant vs. warfarin, the currently most prescribed treatment for VTE in the UK.Study design: A Markov model was built using data from the Hokusai-VTE randomised controlled trial to estimate the lifetime costs and quality-adjusted life years (QALYs) in patients with VTE treated with edoxaban or warfarin over a lifetime horizon, from the UK National Health Services perspective. The model included VTE recurrences, VTE-related complications (post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension), and several types of bleeds associated with anticoagulation treatment. Patients were treated during a period of 6 months after the first VTE event, followed by flexible treatment duration (from 6 months to lifetime) after recurrence, i.e., tertiary prevention.Results: Edoxaban was found dominant vs. warfarin with 0.033 additional QALY and £55 less costs. The reduction of patient management costs, specifically monitoring costs, outweighed the higher drug costs. Edoxaban was dominant in all subgroups (index DVT only, all PE cases (PE with or without DVT), PE without DVT and PE with DVT). Cost-savings ranged from £54 to £81 while additional QALYs ranged from 0.031 to 0.046. Edoxaban was found dominant in 88.6% of cases and cost-effective in additional 10.9% of cases considering a £20,000 threshold in the probabilistic sensitivity analysis.Conclusion: Edoxaban may improve patients’ quality of life in a lifetime horizon without additional costs for the healthcare system due to lower bleeding risk and no monitoring cost compared to warfarin.

show abstract

Reduction in the length of stay with rivaroxaban as a single-drug regimen for the treatment of deep vein thrombosis and pulmonary embolism

Cited by 94 publications

References 29 publications

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions

Use of Prestudy Heparin Did Not Influence the Efficacy and Safety of Rivaroxaban in Patients Treated for Symptomatic Venous Thromboem‐bolism in the EINSTEIN DVT and EINSTEIN PE Studies

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

Contact Info

Product

Resources

About