Pulmonary Vascular Disease: Pulmonary Embolism: Assessment and Outcomes |

Health-care Cost Comparison of Rivaroxaban and Warfarin Use for VTE FREE TO VIEW

Christopher Baugh, MD; Craig Coleman, PharmD; Concetta Crivera, PharmD; Dejan Milentijevic, PhD; Sheng-Wei Wang, PhD; Lang Lu, MS; Winnie Nelson, PharmD
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Janssen Scientific Affairs, Raritan, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1158A. doi:10.1016/j.chest.2016.08.1267
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SESSION TITLE: Pulmonary Embolism: Assessment and Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 04:30 PM - 05:30 PM

PURPOSE: Rivaroxaban is comparable to warfarin for the treatment of venous thromboembolism (VTE). We assessed the total healthcare costs up to 12 months following a VTE event among patients prescribed rivaroxaban or warfarin.

METHODS: We analyzed adult health care claims from the Truven Health MarketScan Commercial Claims and Encounters Database from 11/2012 to 7/2015. We included patients with a claim for rivaroxaban or warfarin within 7 days of their index event (deep vein thrombosis [DVT] or pulmonary embolism [PE]). We excluded patients with any VTE visits or anticoagulant prescriptions during 12 months prior to the index event. Rivaroxaban and warfarin users were 1:2 propensity-score matched based on demographics (age, sex, region and insurance type), resource utilization, and VTE risk factors during the 12-months prior to the index event, with exact matching on whether the index event was DVT or PE. We observed patients for a maximum of 12-months after the index visit, until end of data availability, or discontinuation of insurance coverage. We compare total health care costs including all-cause inpatient, outpatient and pharmacy costs were compared between rivaroxaban and warfarin users using a generalized linear model (log link and gamma distribution).

RESULTS: We found matches for 10,929 rivaroxaban and 21,858 warfarin patients, and most of the patient characteristics were well balanced (standardized difference<10%). The mean (SD) follow-up durations for DVT patients were 317 (81) and 321 (88) days, and PE patients were 313 (85) and 318 (90) days, treated with rivaroxaban and warfarin, respectively. Mean overall cost of up to 12 months was significantly lower for rivaroxaban than warfarin ($20,972 vs. $22,088, p=0.0010). The cost difference was driven mainly by lower inpatient and outpatient costs in the rivaroxaban cohort, despite higher pharmacy costs associated with rivaroxaban treatment.

CONCLUSIONS: In the 12-months following an index VTE event, rivaroxaban was associated with significantly lower total healthcare costs despite higher pharmacy costs. These significant health care cost savings are the result of lower inpatient and outpatient visit costs among rivaroxaban treated patients.

CLINICAL IMPLICATIONS: Despite its increased pharmacy cost compared to warfarin, rivaroxaban use may reduce post-VTE 12-month healthcare costs.

DISCLOSURE: Christopher Baugh: Consultant fee, speaker bureau, advisory committee, etc.: Advisory Board Member - Roche Diagnostics, Consultant fee, speaker bureau, advisory committee, etc.: Paid speaker - Roche Diagnostics, Grant monies (from industry related sources): C-investigator on Janssen funded study, Grant monies (from industry related sources): Co-investigator on Boehringer Ingelheim funded study Craig Coleman: Grant monies (from industry related sources): Janssen Pharmaceuticals; Bayer Pharma AG and Boehringer-Ingelheim Pharmaceuticals, Inc. Concetta Crivera: Employee: Johnson and Johnson, Shareholder: Stockholder of more that $10,000 of JNJ stock Dejan Milentijevic: Employee: Johnson and Johnson Sheng-Wei Wang: Employee: Johnson and Johnson Lang Lu: Employee: Johnson and Johnson, Shareholder: owns in excess of $10,000 of JNJ stock Winnie Nelson: Employee: Johnson and Johnson, Shareholder: owns in excess of $10,000 of JNJ stock

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