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Cardiovascular Disease |

Comparison of Short-Term Bleeding-Related Health Care Utilization and Costs Among Treatment-Naïve Nonvalvular Atrial Fibrillation Patients Initiating Apixaban, Dabigatran, Rivaroxaban, or Warfarin FREE TO VIEW

Alpesh Amin, MD; Allison Keshishian, MPH; Lin Xie, MS; Onur Baser, PhD; Kwanza Price, MPH; Lien Vo, PharmD; Prianka Singh, PharmD; Amanda Bruno, PhD; Jack Mardekian, PhD; Wilson Tan, MD; Shalabh Singhal, MD; Chad Patel, PharmD; Kevin Odell, PharmD; Jeffrey Trocio, MPH
Author and Funding Information

STATinMED Research, Ann Arbor, MI


Chest. 2015;148(4_MeetingAbstracts):65A. doi:10.1378/chest.2253437
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Abstract

SESSION TITLE: Cardiovascular Disease Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To compare health care utilization and costs for major bleeding after initiation of oral anticoagulants (OACs) among treatment-naïve non-valvular atrial fibrillation (NVAF) patients.

METHODS: Adult patients in the Medicare advantage population who were prescribed apixaban, rivaroxaban, dabigatran or warfarin were selected from the Optum Research Database between 01JAN2013 through 31DEC2014. The first OAC prescription date was designated as the index date. Patients were required to have an NVAF diagnosis before the index date, continuous health plan enrollment for 6 months pre-index date, and no OAC claims during the baseline period. Patients were categorized into four cohorts based on their index prescription: apixaban, dabigatran, rivaroxaban and warfarin. Major bleeding event claims within 90 days of the index date were captured and associated health care utilizations and costs were calculated per patient per month (PPPM). Major bleeding-related health care resource utilization and costs were compared using propensity score-weighted generalized linear models.

RESULTS: There were 25,847 patients included in the study, of which 1,778 were prescribed apixaban. The major bleeding incidence rate within 90 days of the index date was significantly lower in apixaban patients (12.0 per 100 person-years) compared to rivaroxaban (23.5 per 100 person-years, p<0.001) and warfarin (25.6 per 100 person-years, p<0.001) patients and trended towards numerically lower major bleeding incidence compared to dabigatran patients. After adjusting for baseline characteristics and demographics, patients treated with apixaban were significantly less likely to have a major bleeding-related inpatient stay (1.4%) compared to those treated with dabigatran (2.4%, p=0.017), rivaroxaban (3.2%, p<0.001) or warfarin (3.2%, p<0.001). Apixaban patients had significantly lower major bleeding-related medical costs PPPM within 90 days ($38) compared to rivaroxaban ($109, p<0.001) and warfarin ($114, p<0.001) patients and numerically lower major bleeding-related costs compared to dabigatran ($40, p=0.870) patients.

CONCLUSIONS: Treatment-naïve NVAF patients prescribed apixaban were significantly less likely to have a major bleeding event within 90 days of treatment initiation compared to those prescribed rivaroxaban or warfarin.

CLINICAL IMPLICATIONS: Apixaban patients incurred significantly lower major bleeding-related costs compared to those prescribed rivaroxaban and warfarin.

DISCLOSURE: Alpesh Amin: Consultant fee, speaker bureau, advisory committee, etc.: Alpesh Amin is a paid consultant for Pfizer Inc. Allison Keshishian: Consultant fee, speaker bureau, advisory committee, etc.: Allison Keshishian is an employee of STATinMED Research, which is a paid consultant for Pfizer Inc. and Bristol-Myers Squibb. Lin Xie: Consultant fee, speaker bureau, advisory committee, etc.: Lin Xie is an employee of STATinMED Research, which is a paid consultant to Pfizer Inc. and Bristol-Myers Squibb. Onur Baser: Consultant fee, speaker bureau, advisory committee, etc.: Onur Baser is an employee of STATinMED Research, which is a paid consultant for Pfizer Inc. and Bristol-Myers Squibb. Kwanza Price: Employee: Kwanza Price is an employee of Pfizer Inc. Lien Vo: Employee: Lien Vo is an employee of Bristol-Myers Squibb. Prianka Singh: Employee: Prianka Singh is an employee of Bristol-Myers Squibb. Amanda Bruno: Employee: Amanda Bruno is an employee of Bristol-Myers Squibb. Jack Mardekian: Employee: Jack Mardekian is an employee of Pfizer Inc. Wilson Tan: Employee: Wilson Tan is an employee of Pfizer Inc. Shalabh Singhal: Employee: Shalabh Singhal is an employee of Bristol-Myers Squibb. Chad Patel: Employee: Chad Patel is an employee of Bristol-Myers Squibb. Kevin Odell: Employee: Kevin Odell is an employee of Pfizer Inc. Jeffrey Trocio: Employee: Jeffrey Trocio is an employee of Pfizer Inc.

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