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

Margolis, Jay; Deitelzweig, Steven; Kline, Jeffrey A.; Tran, Oth; Smith, David M.; Bookhart, Brahim; Crivera, Concetta; Schein, Jeff

doi:10.1161/jaha.116.003788

Cited by 23 publications

(23 citation statements)

References 17 publications

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“…Nonetheless, we found a long hospital stay and more so in the case of older patients reflecting probably the case severity, even though completion of the 5-10 days of the parenteral anticoagulant therapy could have been a deciding factor [6]. However, we found no difference in hospital stay length between patients receiving non-AVK oral anticoagulants versus those receiving parenteral anticoagulant, as opposed to recent studies showing that PTE in patients treated with NOAC had shorter hospital stays [17,18].…”

Section: Discussioncontrasting

confidence: 91%

Pulmonary thromboembolism in an emergency hospital: Are our patients different?

Balahura

Guta

Mihalcea

et al. 2017

Romanian Journal of Internal Medicine

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Introduction. Pulmonary thromboembolism (PTE) represents a medical emergency and is the third most common cause of mortality after myocardial infarction and stroke. The purpose of this study was to describe the characteristics and management of patients with PTE admitted in a referral emergency hospital in Romania.Material and methods. We retrospectively reviewed all cases of PTE diagnosed in one of the largest emergency hospitals in Bucharest during a 2-year period (January 2014 -December 2016. Patients with acute PTE were identified by a database search of the diagnostic codes of all discharge diagnoses. Demographic, clinical and paraclinical tests data was retrieved from medical records.Results. 221 patients (48.87% male, mean age 61.76 years (range 21-94 years)) were diagnosed with PTE in our hospital (0.31% of all hospitalizations). Dyspnea was the most frequent symptom reported (78.9%), followed by pleuritic chest pain (23.9%) and unilateral leg pain (15.8%). Upon presentation, 12.6% of patients had high-risk PTE. Up to 72.8% of patients had at least one thrombotic risk factor, while cancer (14%) was the most frequent amongst them. The mean length of hospitalization was 10.3 ± 4.6 days. Unfractioned heparin (UFH) was the preferred anticoagulant during hospital stay (73.7%, p < 0.001). Vitamin K antagonists (AVK) were the preferred anticoagulant (71.7%, p < 0.001) after discharge, whereas non-antivitamin K oral anticoagulants (NOAC) were recommended in 26.3% of patients. Thrombolysis was used in 18 (8.4%) cases. Mortality was 0.9%.Younger patients more frequently associated thrombophilia or a previous thromboembolic event and clinical signs of DVT at presentation. Older patients associated more frequently a history of hospitalization for heart failure or atrial fibrillation during the previous 3 months and a history of cancer. The clinical presentation in older patients was more severe, with higher PESI scores (103.6 ± 33.4 vs. 55.5 ± 17.9, p<0.001) and a longer hospital stay (10.7 ± 4.7 vs. 9.2 ± 3.9, p = 0.03). The type of anticoagulant treatment did not differ depending on age.Conclusion. In our emergency hospital, PTE is a relatively rare cause of hospitalization; the rate is, however, comparable with other major hospitals. Dyspnea and pleuritic chest pain was the clinical presentation dyad. UFH was the preferred anticoagulant for in-hospital treatment while AVK was the preferred option for long term treatment and recurrence prophylaxis; however an increasing number of patients are prescribed NOAC. In older patients clinical severity was higher upon presentation, hospitalization duration was increased and cancer was more frequently associated. Younger patients associated more frequently a primary hypercoagulable state and recurrent thromboembolism. Mortality rate was low during hospitalization, comparable with that seen in other studied populations.

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Section: Discussioncontrasting

confidence: 91%

Pulmonary thromboembolism in an emergency hospital: Are our patients different?

Balahura

Guta

Mihalcea

et al. 2017

Romanian Journal of Internal Medicine

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“…Several studies have investigated the cost benefits of NOACs compared with warfarin using real‐world claims data or Markov models [ 26‐28 ] ; however, there are less data comparing costs between different NOACs. [ 29,30 ] Using the IMS Pharmetrics Plus database, Lin et al .…”

Section: Discussionmentioning

confidence: 99%

Comparison of healthcare costs among patients with non‐valvular atrial fibrillation treated with warfarin who switched to a novel oral anticoagulant

Franchino‐Elder

Gilligan

Song

et al. 2020

J Pharm Health Serv Res

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Objective To compare all‐cause healthcare costs among non‐valvular atrial fibrillation (NVAF) patients who switched from warfarin to novel oral anticoagulants (NOAC). Methods Adult NVAF patients who switched from warfarin to dabigatran, rivaroxaban or apixaban were identified in MarketScan claims databases between 10/01/2010 and 12/31/2015. Patients were continuously enrolled for 12 months before the first NOAC claim and followed for 12 months or until medication switch, discontinuation, inpatient death or 12/31/2016. Dabigatran patients were matched 1 : 1 separately to rivaroxaban and apixaban. All‐cause costs were reported as per‐patient‐per‐month (PPPM) in 2017 US dollars. Key findings A total of 8679 and 5761 dabigatran switchers were matched to rivaroxaban and apixaban switchers respectively (mean age 73–74 years; mean CCI 1.8–2.0). Compared with rivaroxaban, dabigatran switchers had significantly lower PPPM mean outpatient (OP) ($1265 versus $1587, P < 0.001), emergency department (ED, $67 versus $95, P < 0.001), OP office ($114 versus $119, P = 0.003), other OP services ($1085 versus $1373, P < 0.001) and OP pharmacy costs ($624 versus $660, P < 0.001). Compared with apixaban, dabigatran switchers had significantly lower mean PPPM ED ($67 versus $123, P < 0.001), OP office ($116 versus $121, P = 0.032), other OP services ($1062 versus $1434, P < 0.001), OP pharmacy ($633 versus $706, P < 0.001) and total healthcare costs ($3254 versus $3805, P = 0.016). Conclusions Outpatient costs were considerably lower among dabigatran switchers compared with rivaroxaban. Total and OP healthcare costs were significantly lower for patients switching from warfarin to dabigatran versus apixaban. Use of dabigatran following warfarin discontinuation may enable healthcare cost savings among NVAF patients, as compared with rivaroxaban or apixaban.

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“…Karena, jika kedua penyakit tersebut tidak segera diatasi dengan tepat, dapat menimbulkan komplikasi serius bahkan mengakibatkan kematian (Sinombor, 2010). Di Amerika Serikat, diperkirakan bahwa angka kejadian VTE adalah 1 -3 per 1.000 orang pertahun, dengan dua per tiganya merupakan kasus DVT (Margolis et al, 2016). Belum ada penelitian mengenai angka kejadian DVT di Indonesia secara nasional, namun berdasarkan penelitian Yaznil (2010) mengenai prevalensi DVT pada pasien tumor ginekologi risiko tinggi dan risiko rendah di RS H. Adam Malik menyatakan bahwa prevalensi DVT pada pasien tumor ginekologi risiko tinggi adalah 149 per 1000 populasi berisiko sedangkan pada pasien tumor ginekologi risiko rendah adalah 14 per 1000 populasi berisiko.…”

Section: Pendahuluanunclassified

Evaluasi Ekonomi Parsial antara Pemberian Terapi Rivaroxaban dan Terapi Kombinasi (Unfractionated Heparin + Warfarin) untuk Pengobatan Trombosis Vena Dalam pada Pasien Kanker di Rumah Sakit Kanker Dharmais

2020

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Abstrak Berdasarkan penelitian sebelumnya, diketahui bahwa terapi rivaroxaban memiliki beberapa kelebihan dibandingkan dengan terapi kombinasi (UFH+warfarin) untuk pengobatan trombosis vena dalam (deep vein thrombosis/DVT). Akan tetapi, masih sedikit dokter di RS Kanker Dharmais yang memberikan terapi rivaroxaban untuk pengobatan DVT. Penelitian evaluasi ekonomi parsial ini bertujuan untuk menganalisis outcome dan besarnya biaya yang dibutuhkan dari perspektif rumah sakit antara pemberian terapi rivaroxaban dan terapi kombinasi (UFH+warfarin) untuk pengobatan DVT pada pasien kanker di Rumah Sakit Kanker Dharmais tahun 2016 – 2018. Desain penelitian ini adalah kohort retrospektif dengan unit analisis individu. Karena keterbatasan jumlah pasien yang mendapatkan terapi rivaroxaban selama 3 – 6 bulan, studi ini menganalisis biaya dan outcome dari pasien yang mendapatkan terapi selama 1 bulan. Outcome yang diukur adalah intermediate outcome, yang meliputi lama hari rawat, kesembuhan, dan kejadian perdarahan. Biaya dihitung berdasarkan biaya yang dibebankan kepada pasien (charge), yang meliputi biaya obat, pemeriksaan penunjang, tindakan, serta administrasi dan akomodasi. Hasil penelitian menunjukkan bahwa untuk outcome terapi rivaroxaban, sebagian besar pasien tidak mendapatkan perawatan rawat inap, 40% pasien dinyatakan sembuh dari DVT, dan tidak ada pasien yang mengalami kejadian perdarahan. Rata-rata biaya terapi rivaroxaban adalah Rp 7.169.383,00 per pasien. Untuk outcome terapi kombinasi (UFH+warfarin), sebagian besar pasien memiliki lama hari rawat antara 8 – 14 hari, 46% pasien dinyatakan sembuh dari DVT, dan tidak ada pasien yang mengalami kejadian perdarahan. Rata-rata biaya terapi kombinasi (UFH+warfarin) adalah Rp 11.878.813,00 per pasien.Abstract Based on previous studies, rivaroxaban therapy has several advantages compared to combination therapy (UFH+warfarin) for the treatment of deep vein thrombosis (DVT). However, the use of rivaroxaban in Dharmais Cancer Hospital is still low. This partial economic evaluation study aims to analyze cost and outcome of rivaroxaban therapy and combination therapy (UFH+warfarin) for DVT treatment in cancer patients at the Dharmais Cancer Hospital during 2016 – 2018. Data collection was done using cohort-retrospective and individual unit of analysis. Due to limited number of patient treated with rivaroxaban therapy within 3-6 months, we estimated the cost and outcome related to patients who were successfully treated in one month. The outcome was the intermediate outcome, i.e length of stay, recovery, and the occurrence of bleeding. The cost was calculated based on hospital perspective including drugs, laboratory tests, procedures, as well as the administrative and accommodation costs. The results showed that patients with rivaroxaban therapy were not admitted to inpatient care, 40% of patients were recovered from DVT, and none of the patients experienced bleeding. The average cost of rivaroxaban therapy to reach the expected outcome was Rp 8,824,791.00. The study also showed that patients with combination therapy (UFH+warfarin) had a hospital length of stay between 8 to 14 days, 46% of patients were recovered from DVT, and none of the patients experienced bleeding. The average cost of combination therapy (UFH+warfarin) to reach the expected outcome was Rp 13,201,698.00.

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

Cited by 23 publications

References 17 publications

Pulmonary thromboembolism in an emergency hospital: Are our patients different?

Pulmonary thromboembolism in an emergency hospital: Are our patients different?

Comparison of healthcare costs among patients with non‐valvular atrial fibrillation treated with warfarin who switched to a novel oral anticoagulant

Evaluasi Ekonomi Parsial antara Pemberian Terapi Rivaroxaban dan Terapi Kombinasi (Unfractionated Heparin + Warfarin) untuk Pengobatan Trombosis Vena Dalam pada Pasien Kanker di Rumah Sakit Kanker Dharmais

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