Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: A cost analysis

Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban i...

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Veröffentlicht in:Phlebology 2018-02, Vol.33 (1), p.53-59
Hauptverfasser: Diken, Adem İ, Yalçınkaya, Adnan, Hanedan, Muhammet O, Erol, Mehmet E, Ercen Diken, Özlem
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container_end_page 59
container_issue 1
container_start_page 53
container_title Phlebology
container_volume 33
creator Diken, Adem İ
Yalçınkaya, Adnan
Hanedan, Muhammet O
Erol, Mehmet E
Ercen Diken, Özlem
description Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p 
doi_str_mv 10.1177/0268355516688358
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The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p &lt; 0.001). But annual drug cost is higher in rivaroxaban group (362.6 vs. 71.55 ± 31.01 USD p &lt; 0.001). Overall cost of rivaroxaban group is higher than warfarin group (476.25 ± 36.78 vs. 364.82 ± 174.44 USD). Warfarin is not cost-effective when non-drug costs (342.5 ± 174.44 vs. 113.65 ± 36.77) and hospital costs (173.85 ± 122.73 vs. 64.9 ± 23.55 USD) were analyzed. Conclusion This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits.</description><identifier>ISSN: 0268-3555</identifier><identifier>EISSN: 1758-1125</identifier><identifier>DOI: 10.1177/0268355516688358</identifier><identifier>PMID: 28056701</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><ispartof>Phlebology, 2018-02, Vol.33 (1), p.53-59</ispartof><rights>The Author(s) 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-4c4e0e5964b6bc29042ee4749e98b992faf8377b16a0b0a8d070f0a3202e4c393</citedby><cites>FETCH-LOGICAL-c337t-4c4e0e5964b6bc29042ee4749e98b992faf8377b16a0b0a8d070f0a3202e4c393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0268355516688358$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0268355516688358$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28056701$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Diken, Adem İ</creatorcontrib><creatorcontrib>Yalçınkaya, Adnan</creatorcontrib><creatorcontrib>Hanedan, Muhammet O</creatorcontrib><creatorcontrib>Erol, Mehmet E</creatorcontrib><creatorcontrib>Ercen Diken, Özlem</creatorcontrib><title>Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: A cost analysis</title><title>Phlebology</title><addtitle>Phlebology</addtitle><description>Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p &lt; 0.001). But annual drug cost is higher in rivaroxaban group (362.6 vs. 71.55 ± 31.01 USD p &lt; 0.001). Overall cost of rivaroxaban group is higher than warfarin group (476.25 ± 36.78 vs. 364.82 ± 174.44 USD). Warfarin is not cost-effective when non-drug costs (342.5 ± 174.44 vs. 113.65 ± 36.77) and hospital costs (173.85 ± 122.73 vs. 64.9 ± 23.55 USD) were analyzed. Conclusion This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits.</description><issn>0268-3555</issn><issn>1758-1125</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kEtLw0AQxxdRbK3ePcl-gdTZzWN3vZXiCwqC6MlDmE0mmtJky24a229vStWD4GGYgf8D5sfYpYCpEEpdg8x0nKapyDI9HPqIjYVKdSSETI_ZeC9He33EzkJYAoBUSp2ykdSQZgrEmL091z16t0WLLe_DlH-ir9DXLXctp21HbUklL4nWvKfWbQLvPrxrrKNhVnVoeOcJu4ba7obPeOFCx7HF1S7U4ZydVLgKdPG9J-z17vZl_hAtnu4f57NFVMSx6qKkSAgoNVliM1tIA4kkSlRiyGhrjKyw0rFSVmQIFlCXoKACjCVISorYxBMGh97CuxA8Vfna1w36XS4g33PK_3IaIleHyHpjGyp_Az9gBkN0MAR8p3zpNn54Kvxf-AXYk3CS</recordid><startdate>201802</startdate><enddate>201802</enddate><creator>Diken, Adem İ</creator><creator>Yalçınkaya, Adnan</creator><creator>Hanedan, Muhammet O</creator><creator>Erol, Mehmet E</creator><creator>Ercen Diken, Özlem</creator><general>SAGE Publications</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>201802</creationdate><title>Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: A cost analysis</title><author>Diken, Adem İ ; Yalçınkaya, Adnan ; Hanedan, Muhammet O ; Erol, Mehmet E ; Ercen Diken, Özlem</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-4c4e0e5964b6bc29042ee4749e98b992faf8377b16a0b0a8d070f0a3202e4c393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Diken, Adem İ</creatorcontrib><creatorcontrib>Yalçınkaya, Adnan</creatorcontrib><creatorcontrib>Hanedan, Muhammet O</creatorcontrib><creatorcontrib>Erol, Mehmet E</creatorcontrib><creatorcontrib>Ercen Diken, Özlem</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Phlebology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Diken, Adem İ</au><au>Yalçınkaya, Adnan</au><au>Hanedan, Muhammet O</au><au>Erol, Mehmet E</au><au>Ercen Diken, Özlem</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: A cost analysis</atitle><jtitle>Phlebology</jtitle><addtitle>Phlebology</addtitle><date>2018-02</date><risdate>2018</risdate><volume>33</volume><issue>1</issue><spage>53</spage><epage>59</epage><pages>53-59</pages><issn>0268-3555</issn><eissn>1758-1125</eissn><abstract>Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p &lt; 0.001). But annual drug cost is higher in rivaroxaban group (362.6 vs. 71.55 ± 31.01 USD p &lt; 0.001). Overall cost of rivaroxaban group is higher than warfarin group (476.25 ± 36.78 vs. 364.82 ± 174.44 USD). Warfarin is not cost-effective when non-drug costs (342.5 ± 174.44 vs. 113.65 ± 36.77) and hospital costs (173.85 ± 122.73 vs. 64.9 ± 23.55 USD) were analyzed. Conclusion This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>28056701</pmid><doi>10.1177/0268355516688358</doi><tpages>7</tpages></addata></record>
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