Author + information
- Alpesh Amina,b,
- Allison Keshishiana,b,
- Jeffrey Trocioa,b,
- Hannah Lea,b,
- Oluwaseyi Dinaa,b,
- Zhang Qisua,b,
- Onur Basera,b and
- Lien Voa,b
Background: Clinical trials have demonstrated that direct oral anticoagulants (DOACs) are associated with similar or lower rates of major bleeding (MB) compared to warfarin. However, few studies have evaluated the MB-related medical costs. This study compared risk of MB and MB-related medical costs among non-valvular atrial fibrillation (NVAF) patients initiating oral anticoagulants.
Methods: NVAF patients ≥65 years in the US Medicare database newly prescribed apixaban, rivaroxaban, dabigatran or warfarin were selected from 01JAN2013-31DEC2014. MB was identified using primary ICD-9 codes from hospitalization claims and MB-related medical costs were calculated per patient per month (PPPM) and included all claims with a MB diagnosis. 1:1 propensity score matching was used to balance demographics and clinical characteristics. Cox proportional hazards models were used to estimate hazard ratio (HR) of MB between the NOACs and warfarin.
Results: The three matched cohorts were balanced with mean age of 77-78 years and CHA2DS2-VASc score of 4.4-4.7. Apixaban and dabigatran initiators had significantly lower risk of MB and significantly lower MB-related costs compared to warfarin initiators. Rivaroxaban initiators had higher risk of MB but similar MB costs compared to warfarin initiators (Table).
Conclusions: In the US Medicare population, NVAF patients prescribed apixaban and dabigatran had significantly lower risk of MB and MB-related medical costs compared to those prescribed warfarin.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Anticoagulation Issues
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1189-085
- 2017 American College of Cardiology Foundation