Author + information
- Steven Deitelzweiga,b,
- Xuemei Luoa,b,
- Kiran Guptaa,b,
- Jeffrey Trocioa,b,
- Jack Mardekiana,b,
- Tammy Cuticea,b,
- Melissa Lingohr-Smitha,b,
- Brandy Mengesa,b and
- Jay Lina,b
Background: Elderly patients are at an increased risk of bleeding and healthcare resource use. Few studies have evaluated the impact of apixaban vs. warfarin on the risk of major bleeding and associated costs among elderly patients with nonvalvular atrial fibrillation (NVAF) in the real-world setting.
Objective: To compare the risk of major bleeding and costs for all causes and bleeding-related health services among elderly NVAF patients treated with apixaban vs. warfarin in the US.
Methods: Patients initiating apixaban or warfarin (index event) were identified from the Humana database (1/1/2013-9/30/2015). Patients were required to be ≥ 65 years, have an NVAF diagnosis and 12 months of continuous health plan enrollment (baseline period) prior to the index event date. Propensity score matching (PSM) was conducted to balance baseline patient characteristics. Risk of major bleeding (bleeding event requiring hospitalization based on the 1st listed ICD-9-CM codes) and bleeding-related as well as all-cause healthcare costs during the follow-up period were compared between patients receiving apixaban vs. warfarin.
Results: By implementing PSM, 14,214 patients were matched, with 7,107 in each cohort. Mean ages, CCI score, and stroke and bleeding risks at baseline were similar between matched cohorts. Compared to warfarin, apixaban treatment was associated with a significantly lower risk of major bleeding (hazard ratio (95% confidence interval): 0.53 (0.45, 0.63)). Apixaban treatment was also associated with significantly lower bleeding-related inpatient costs (mean costs per patient per year (PPPY): $1847 vs. $3653, p <0.0001) and bleeding-related overall medical costs ($2101 vs. $3963, p<0.0001) vs. warfarin. After including pharmacy costs, all-cause total healthcare costs were also significantly lower for patients treated with apixaban as compared to warfarin (PPPY: $23,141 vs. 28,633, p <0.0001).
Conclusions: In the real-world setting after balancing patient characteristics, apixaban treatment is associated with significantly lower risk of major bleeding as well as significantly lower costs for all causes and bleeding-related health services among elderly NVAF patients in the US.
Moderated Poster Contributions
Arrhythmias and Clinical EP Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 10:15 a.m.-10:25 a.m.
Session Title: Atrial Fibrillation, Anticoagulation and Novel Device Therapies
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1134M-05
- 2017 American College of Cardiology Foundation