Pulmonary Embolism Inpatients Treated With Rivaroxaban Had Shorter Hospital Stays and Lower Costs Compared With Warfarin

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• 作者：Jay M. Margolis ; PharmD¹ ; ^{jay.margolis@truvenhealth.com" class="auth_mail" title="E-mail the corresponding author} ; Steven Deitelzweig ; MD² ; Jeffrey Kline ; MD³ ; Oth Tran ; MA⁴ ; David M. Smith ; PhD⁴ ; Concetta Crivera ; PharmD⁵ ; Brahim Bookhart ; MBA⁵ ; Jeff Schein ; DrPH⁵
• 关键词：hospitalization costs ; length of stay ; pulmonary embolism ; rivaroxaban ; warfarin
• 刊名：Clinical Therapeutics
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：38
• 期：11
• 页码：2496-2503
• 全文大小：271 K

文摘

Using real-world data, this study compares inpatient length of stay (LOS) and costs for patients with a primary diagnosis of pulmonary embolism (PE) initiating treatment with oral anticoagulation with rivaroxaban versus warfarin.

Methods

Hospitalizations from MarketScan’s Hospital Drug Database were selected from November 1, 2012, through December 31, 2013, for adults with a primary diagnosis of PE initiating treatment with rivaroxaban or warfarin. Warfarin patients were matched 1:1 to rivaroxaban patients using exact and propensity score matching. Hospital LOS, treatment patterns, and hospitalization costs were evaluated.

Findings

Matched cohorts included 751 rivaroxaban-treated patients and 751 warfarin-treated patients. Adjusted mean LOS was 3.77 days for rivaroxaban patients (95% CI, 3.66–3.87 days) and 5.48 days for warfarin patients (95% CI, 5.33–5.63 days; P < .001). Mean (SD) LOS was shorter for patients taking rivaroxaban whether admission was for provoked PE (rivaroxaban: 5.2 [5.1] days; warfarin: 7.0 [6.5] days; P < .001) or unprovoked PE (rivaroxaban: 3.4 [2.3] days; warfarin: 5.1 [2.7] days; P < .001). Mean (SD) days from first dose to discharge were 2.5 (1.7) (rivaroxaban) and 4.0 (2.9) (warfarin) when initiated with parenteral anticoagulants (P < .001) and 2.7 (1.7) (rivaroxaban) and 4.0 (2.2) (warfarin) without parenteral anticoagulants (P < .001). The rivaroxaban cohort incurred significantly lower unadjusted mean (SD) hospitalization costs (rivaroxaban: $8473 [$9105]; warfarin: $10,291 [$9185]; P < .001), confirmed by covariate adjustment with generalized linear modeling estimating predicted mean hospitalization costs of $8266 for rivaroxaban patients (95% CI, $7851–$8681) and $10,511 for warfarin patients (95% CI, $10,031–$10,992; P < .001).

Implications

patients with PE treated with rivaroxaban incurred significantly lower hospitalization costs by $2245 per admission compared with patients treated with warfarin, which was attributable to cost offsets from 1.71 fewer days of stay in the hospital.