Costs of hospital visits among patients with deep vein thrombosis treated with rivaroxaban and LMWH/warfarin.
J Med Econ. 2015 Sep 21;:1-17
Authors: Merli GJ, Hollander JE, Lefebvre P, Laliberté F, Raut MK, Germain G, Bookhart B, Pollack CV
Abstract
BACKGROUND: For many years, the standard of care for patients diagnosed with deep vein thrombosis (DVT) has been low-molecular-weight heparin (LMWH) bridging to an oral Vitamin-K antagonist (VKA). The availability of new non-VKA oral anticoagulants (NOAC) agents as monotherapy may reduce the likelihood of hospitalization for DVT patients.
OBJECTIVE: To compare hospital visit costs of DVT patients treated with rivaroxaban and LMWH/warfarin.
METHODS: A retrospective claim analysis was conducted using the MarketScan Hospital Drug Database for care provided between 01/2011 and 12/2013. Adult patients using rivaroxaban or LMWH/warfarin with a primary diagnosis of DVT during the first day of a hospital visit were identified (i.e., index hospital visit). Based on propensity-score methods, historical LMWH/warfarin patients (i.e., patients who received LMWH/warfarin before the approval of rivaroxaban) were matched 4:1 to rivaroxaban patients. The hospital-visit cost difference between these groups was evaluated for the index hospital visit, as well as for total hospital-visit costs (i.e., including index and subsequent hospital visit costs).
RESULTS: All rivaroxaban users (N=134) in the database were well-matched with 4 LMWH/warfarin users (N=536). The mean hospital-visit costs were $5,257 for the rivaroxaban cohort and $6,764 in the matched-cohort of patients using LMWH/warfarin. The $1,508 cost difference was statistically significant between cohorts (95% CI: [$-2,296; $-580]; P-value=0.002). Total hospital-visit costs were lower for rivaroxaban compared to LMWH/warfarin users within 1, 2, 3, and 6 months after index visit (significantly lower within 1 and 3 months, p-values <.05) Limitations: Limitations inherent to administrative-claims data, completeness of baseline characteristics, adjustments restricted to observational factors, and lastly the sample size of the rivaroxaban cohort.
CONCLUSION: The availability of rivaroxaban significantly reduced the costs of hospital visits in patients with DVT treated with rivaroxaban compared to LMWH/warfarin.
PMID: 26390315 [PubMed - as supplied by publisher]