Comparison of real-world clinical and economic outcomes in patients receiving oral anticoagulants: A retrospective claims analysis
Direct oral anticoagulants (DOACs) have become widely used for the prevention of stroke in nonvalvular atrial fibrillation (AF) and for the treatment of venous thromboembolism (VTE). Warfarin, the standard of care prior to DOACs, requires monitoring and dose adjustment to ensure patients remain appr...
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| Veröffentlicht in: | Journal of managed care & specialty pharmacy 2022-11, Vol.28 (11), p.1304-1315 |
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| creator | Karnick, Cameron Modany, Ashley McGraw, Molly Ludwig, Justin Marr, David Hammonds, Tracy Good, Chester B Culley, Eric |
| description | Direct oral anticoagulants (DOACs) have become widely used for the prevention of stroke in nonvalvular atrial fibrillation (AF) and for the treatment of venous thromboembolism (VTE). Warfarin, the standard of care prior to DOACs, requires monitoring and dose adjustment to ensure patients remain appropriately anticoagulated. DOACs do not require monitoring but are significantly more expensive. We sought to examine real-world effectiveness and costs of DOACs and warfarin in patients with AF and VTE.
To examine clinical and economic outcomes. The clinical objectives were to determine the bleeding and thrombotic event rates associated with DOACs vs warfarin. The economic objectives were to determine the cost associated with these events, as well as the all-cause medical and pharmacy costs associated with DOACs vs warfarin.
This analysis was an observational, propensity-matched comparison of retrospective medical and pharmacy claims data for members enrolled in an integrated health plan between October 1, 2015, and September 30, 2020. Members who were older than 18 years of age with at least 1 30-day supply of warfarin or a DOAC filled within 30 days of a new diagnosis of VTE or nonvalvular AF were eligible for the analysis. Cox hazard ratios were used to compare differences in clinical outcomes, where paired t-tests were used to evaluate economic outcomes.
After matching, there were 893 patients in each group. Among matched members, warfarin was associated with increased risk of nonmajor bleeds relative to apixaban (hazard ratio [HR] = 1.526;
= 0.0048) and increased risk of pulmonary embolism relative to both DOACs (apixaban: HR = 1.941 [
= 0.0328]; rivaroxaban: HR = 1.833 [
= 0.0489]). No statistically significant difference was observed in hospitalizations or in length of stay between warfarin and either DOAC. The difference-in-difference (DID) in total costs of care per member per month for apixaban and rivaroxaban relative to warfarin were $801.64 (
= 0.0178) and $534.23 (
= 0.0998) more, respectively. DID in VTE-related cost for apixaban was $177.09 less, relative to warfarin (
= 0.0098). DID in all-cause pharmacy costs for apixaban and rivaroxaban relative to warfarin were $342.47 (
< 0.0001) and $386.42 (
< 0.001) more, respectively.
Warfarin use was associated with a significant decrease in total cost of care despite a significant increase in VTE-related costs vs apixaban. Warfarin was also associated with a significant increase in other nonmajor bleed |
| doi_str_mv | 10.18553/jmcp.2022.28.11.1304 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10372967</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>36282935</sourcerecordid><originalsourceid>FETCH-LOGICAL-c365t-9754d94f8f39072f978481de52d2632131bc029cbc0065f39bcb28dff7194d33</originalsourceid><addsrcrecordid>eNpVkV1PwyAUhonRODP3EzT8gVY4lJZ6Y5bFr2SJN7snjNLJ0kJTupnd-stlHy56AyfhfV_OOQ9Cd5SkVHDOHtat7lIgACmIlNKUMpJdoBtgRZ5QwuDyVBOekRGahLAmhADjuaDsGo1YDgJKxm_Q98y3nept8A77GvdGNcmX75sK68Y6q1WDlauw0d751mrsN4P2rQnYOtypwRo3hOjSxm6tW2HfHwyD1V6tNk2swiOeRsHQ-9AZPditicnKtiHKVLMLNtyiq1o1wUxO9xgtXp4Xs7dk_vH6PpvOE81yPiRlwbOqzGpRs5IUUJeFyAStDIcKcgaU0aUmUOp4kpxH0VIvQVR1XdAyqxgbo6djbLdZtqbSsfPYrOx626p-J72y8v-Ls59y5bcy7rOAMi9iAj8m6DhM6E19NlMiD1zknovcc5EgJKVyzyX67v_-fHb9UmA_wc6OTw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Comparison of real-world clinical and economic outcomes in patients receiving oral anticoagulants: A retrospective claims analysis</title><source>MEDLINE</source><source>PubMed Central</source><creator>Karnick, Cameron ; Modany, Ashley ; McGraw, Molly ; Ludwig, Justin ; Marr, David ; Hammonds, Tracy ; Good, Chester B ; Culley, Eric</creator><creatorcontrib>Karnick, Cameron ; Modany, Ashley ; McGraw, Molly ; Ludwig, Justin ; Marr, David ; Hammonds, Tracy ; Good, Chester B ; Culley, Eric</creatorcontrib><description>Direct oral anticoagulants (DOACs) have become widely used for the prevention of stroke in nonvalvular atrial fibrillation (AF) and for the treatment of venous thromboembolism (VTE). Warfarin, the standard of care prior to DOACs, requires monitoring and dose adjustment to ensure patients remain appropriately anticoagulated. DOACs do not require monitoring but are significantly more expensive. We sought to examine real-world effectiveness and costs of DOACs and warfarin in patients with AF and VTE.
To examine clinical and economic outcomes. The clinical objectives were to determine the bleeding and thrombotic event rates associated with DOACs vs warfarin. The economic objectives were to determine the cost associated with these events, as well as the all-cause medical and pharmacy costs associated with DOACs vs warfarin.
This analysis was an observational, propensity-matched comparison of retrospective medical and pharmacy claims data for members enrolled in an integrated health plan between October 1, 2015, and September 30, 2020. Members who were older than 18 years of age with at least 1 30-day supply of warfarin or a DOAC filled within 30 days of a new diagnosis of VTE or nonvalvular AF were eligible for the analysis. Cox hazard ratios were used to compare differences in clinical outcomes, where paired t-tests were used to evaluate economic outcomes.
After matching, there were 893 patients in each group. Among matched members, warfarin was associated with increased risk of nonmajor bleeds relative to apixaban (hazard ratio [HR] = 1.526;
= 0.0048) and increased risk of pulmonary embolism relative to both DOACs (apixaban: HR = 1.941 [
= 0.0328]; rivaroxaban: HR = 1.833 [
= 0.0489]). No statistically significant difference was observed in hospitalizations or in length of stay between warfarin and either DOAC. The difference-in-difference (DID) in total costs of care per member per month for apixaban and rivaroxaban relative to warfarin were $801.64 (
= 0.0178) and $534.23 (
= 0.0998) more, respectively. DID in VTE-related cost for apixaban was $177.09 less, relative to warfarin (
= 0.0098). DID in all-cause pharmacy costs for apixaban and rivaroxaban relative to warfarin were $342.47 (
< 0.0001) and $386.42 (
< 0.001) more, respectively.
Warfarin use was associated with a significant decrease in total cost of care despite a significant increase in VTE-related costs vs apixaban. Warfarin was also associated with a significant increase in other nonmajor bleeds relative to apixaban, as well as a significant increase in pulmonary embolism relative to both DOACs. Warfarin was associated with a significant reduction in all-cause pharmacy cost compared with either DOAC.
The authors of this study have nothing to disclose.</description><identifier>ISSN: 2376-0540</identifier><identifier>EISSN: 2376-1032</identifier><identifier>DOI: 10.18553/jmcp.2022.28.11.1304</identifier><identifier>PMID: 36282935</identifier><language>eng</language><publisher>United States: Academy of Managed Care Pharmacy</publisher><subject>Administration, Oral ; Anticoagulants - adverse effects ; Atrial Fibrillation - complications ; Atrial Fibrillation - drug therapy ; Hemorrhage ; Humans ; Infant ; Insurance Claim Review ; Pulmonary Embolism - chemically induced ; Pulmonary Embolism - complications ; Pulmonary Embolism - prevention & control ; Pyridones - adverse effects ; Retrospective Studies ; Rivaroxaban - adverse effects ; Stroke - etiology ; Stroke - prevention & control ; Venous Thromboembolism - prevention & control ; Warfarin - adverse effects</subject><ispartof>Journal of managed care & specialty pharmacy, 2022-11, Vol.28 (11), p.1304-1315</ispartof><rights>Copyright © 2022, Academy of Managed Care Pharmacy. All rights reserved. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-9754d94f8f39072f978481de52d2632131bc029cbc0065f39bcb28dff7194d33</citedby><cites>FETCH-LOGICAL-c365t-9754d94f8f39072f978481de52d2632131bc029cbc0065f39bcb28dff7194d33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10372967/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10372967/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36282935$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karnick, Cameron</creatorcontrib><creatorcontrib>Modany, Ashley</creatorcontrib><creatorcontrib>McGraw, Molly</creatorcontrib><creatorcontrib>Ludwig, Justin</creatorcontrib><creatorcontrib>Marr, David</creatorcontrib><creatorcontrib>Hammonds, Tracy</creatorcontrib><creatorcontrib>Good, Chester B</creatorcontrib><creatorcontrib>Culley, Eric</creatorcontrib><title>Comparison of real-world clinical and economic outcomes in patients receiving oral anticoagulants: A retrospective claims analysis</title><title>Journal of managed care & specialty pharmacy</title><addtitle>J Manag Care Spec Pharm</addtitle><description>Direct oral anticoagulants (DOACs) have become widely used for the prevention of stroke in nonvalvular atrial fibrillation (AF) and for the treatment of venous thromboembolism (VTE). Warfarin, the standard of care prior to DOACs, requires monitoring and dose adjustment to ensure patients remain appropriately anticoagulated. DOACs do not require monitoring but are significantly more expensive. We sought to examine real-world effectiveness and costs of DOACs and warfarin in patients with AF and VTE.
To examine clinical and economic outcomes. The clinical objectives were to determine the bleeding and thrombotic event rates associated with DOACs vs warfarin. The economic objectives were to determine the cost associated with these events, as well as the all-cause medical and pharmacy costs associated with DOACs vs warfarin.
This analysis was an observational, propensity-matched comparison of retrospective medical and pharmacy claims data for members enrolled in an integrated health plan between October 1, 2015, and September 30, 2020. Members who were older than 18 years of age with at least 1 30-day supply of warfarin or a DOAC filled within 30 days of a new diagnosis of VTE or nonvalvular AF were eligible for the analysis. Cox hazard ratios were used to compare differences in clinical outcomes, where paired t-tests were used to evaluate economic outcomes.
After matching, there were 893 patients in each group. Among matched members, warfarin was associated with increased risk of nonmajor bleeds relative to apixaban (hazard ratio [HR] = 1.526;
= 0.0048) and increased risk of pulmonary embolism relative to both DOACs (apixaban: HR = 1.941 [
= 0.0328]; rivaroxaban: HR = 1.833 [
= 0.0489]). No statistically significant difference was observed in hospitalizations or in length of stay between warfarin and either DOAC. The difference-in-difference (DID) in total costs of care per member per month for apixaban and rivaroxaban relative to warfarin were $801.64 (
= 0.0178) and $534.23 (
= 0.0998) more, respectively. DID in VTE-related cost for apixaban was $177.09 less, relative to warfarin (
= 0.0098). DID in all-cause pharmacy costs for apixaban and rivaroxaban relative to warfarin were $342.47 (
< 0.0001) and $386.42 (
< 0.001) more, respectively.
Warfarin use was associated with a significant decrease in total cost of care despite a significant increase in VTE-related costs vs apixaban. Warfarin was also associated with a significant increase in other nonmajor bleeds relative to apixaban, as well as a significant increase in pulmonary embolism relative to both DOACs. Warfarin was associated with a significant reduction in all-cause pharmacy cost compared with either DOAC.
The authors of this study have nothing to disclose.</description><subject>Administration, Oral</subject><subject>Anticoagulants - adverse effects</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Infant</subject><subject>Insurance Claim Review</subject><subject>Pulmonary Embolism - chemically induced</subject><subject>Pulmonary Embolism - complications</subject><subject>Pulmonary Embolism - prevention & control</subject><subject>Pyridones - adverse effects</subject><subject>Retrospective Studies</subject><subject>Rivaroxaban - adverse effects</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>Venous Thromboembolism - prevention & control</subject><subject>Warfarin - adverse effects</subject><issn>2376-0540</issn><issn>2376-1032</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkV1PwyAUhonRODP3EzT8gVY4lJZ6Y5bFr2SJN7snjNLJ0kJTupnd-stlHy56AyfhfV_OOQ9Cd5SkVHDOHtat7lIgACmIlNKUMpJdoBtgRZ5QwuDyVBOekRGahLAmhADjuaDsGo1YDgJKxm_Q98y3nept8A77GvdGNcmX75sK68Y6q1WDlauw0d751mrsN4P2rQnYOtypwRo3hOjSxm6tW2HfHwyD1V6tNk2swiOeRsHQ-9AZPditicnKtiHKVLMLNtyiq1o1wUxO9xgtXp4Xs7dk_vH6PpvOE81yPiRlwbOqzGpRs5IUUJeFyAStDIcKcgaU0aUmUOp4kpxH0VIvQVR1XdAyqxgbo6djbLdZtqbSsfPYrOx626p-J72y8v-Ls59y5bcy7rOAMi9iAj8m6DhM6E19NlMiD1zknovcc5EgJKVyzyX67v_-fHb9UmA_wc6OTw</recordid><startdate>202211</startdate><enddate>202211</enddate><creator>Karnick, Cameron</creator><creator>Modany, Ashley</creator><creator>McGraw, Molly</creator><creator>Ludwig, Justin</creator><creator>Marr, David</creator><creator>Hammonds, Tracy</creator><creator>Good, Chester B</creator><creator>Culley, Eric</creator><general>Academy of Managed Care Pharmacy</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>202211</creationdate><title>Comparison of real-world clinical and economic outcomes in patients receiving oral anticoagulants: A retrospective claims analysis</title><author>Karnick, Cameron ; Modany, Ashley ; McGraw, Molly ; Ludwig, Justin ; Marr, David ; Hammonds, Tracy ; Good, Chester B ; Culley, Eric</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-9754d94f8f39072f978481de52d2632131bc029cbc0065f39bcb28dff7194d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Administration, Oral</topic><topic>Anticoagulants - adverse effects</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Infant</topic><topic>Insurance Claim Review</topic><topic>Pulmonary Embolism - chemically induced</topic><topic>Pulmonary Embolism - complications</topic><topic>Pulmonary Embolism - prevention & control</topic><topic>Pyridones - adverse effects</topic><topic>Retrospective Studies</topic><topic>Rivaroxaban - adverse effects</topic><topic>Stroke - etiology</topic><topic>Stroke - prevention & control</topic><topic>Venous Thromboembolism - prevention & control</topic><topic>Warfarin - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karnick, Cameron</creatorcontrib><creatorcontrib>Modany, Ashley</creatorcontrib><creatorcontrib>McGraw, Molly</creatorcontrib><creatorcontrib>Ludwig, Justin</creatorcontrib><creatorcontrib>Marr, David</creatorcontrib><creatorcontrib>Hammonds, Tracy</creatorcontrib><creatorcontrib>Good, Chester B</creatorcontrib><creatorcontrib>Culley, Eric</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of managed care & specialty pharmacy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karnick, Cameron</au><au>Modany, Ashley</au><au>McGraw, Molly</au><au>Ludwig, Justin</au><au>Marr, David</au><au>Hammonds, Tracy</au><au>Good, Chester B</au><au>Culley, Eric</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of real-world clinical and economic outcomes in patients receiving oral anticoagulants: A retrospective claims analysis</atitle><jtitle>Journal of managed care & specialty pharmacy</jtitle><addtitle>J Manag Care Spec Pharm</addtitle><date>2022-11</date><risdate>2022</risdate><volume>28</volume><issue>11</issue><spage>1304</spage><epage>1315</epage><pages>1304-1315</pages><issn>2376-0540</issn><eissn>2376-1032</eissn><abstract>Direct oral anticoagulants (DOACs) have become widely used for the prevention of stroke in nonvalvular atrial fibrillation (AF) and for the treatment of venous thromboembolism (VTE). Warfarin, the standard of care prior to DOACs, requires monitoring and dose adjustment to ensure patients remain appropriately anticoagulated. DOACs do not require monitoring but are significantly more expensive. We sought to examine real-world effectiveness and costs of DOACs and warfarin in patients with AF and VTE.
To examine clinical and economic outcomes. The clinical objectives were to determine the bleeding and thrombotic event rates associated with DOACs vs warfarin. The economic objectives were to determine the cost associated with these events, as well as the all-cause medical and pharmacy costs associated with DOACs vs warfarin.
This analysis was an observational, propensity-matched comparison of retrospective medical and pharmacy claims data for members enrolled in an integrated health plan between October 1, 2015, and September 30, 2020. Members who were older than 18 years of age with at least 1 30-day supply of warfarin or a DOAC filled within 30 days of a new diagnosis of VTE or nonvalvular AF were eligible for the analysis. Cox hazard ratios were used to compare differences in clinical outcomes, where paired t-tests were used to evaluate economic outcomes.
After matching, there were 893 patients in each group. Among matched members, warfarin was associated with increased risk of nonmajor bleeds relative to apixaban (hazard ratio [HR] = 1.526;
= 0.0048) and increased risk of pulmonary embolism relative to both DOACs (apixaban: HR = 1.941 [
= 0.0328]; rivaroxaban: HR = 1.833 [
= 0.0489]). No statistically significant difference was observed in hospitalizations or in length of stay between warfarin and either DOAC. The difference-in-difference (DID) in total costs of care per member per month for apixaban and rivaroxaban relative to warfarin were $801.64 (
= 0.0178) and $534.23 (
= 0.0998) more, respectively. DID in VTE-related cost for apixaban was $177.09 less, relative to warfarin (
= 0.0098). DID in all-cause pharmacy costs for apixaban and rivaroxaban relative to warfarin were $342.47 (
< 0.0001) and $386.42 (
< 0.001) more, respectively.
Warfarin use was associated with a significant decrease in total cost of care despite a significant increase in VTE-related costs vs apixaban. Warfarin was also associated with a significant increase in other nonmajor bleeds relative to apixaban, as well as a significant increase in pulmonary embolism relative to both DOACs. Warfarin was associated with a significant reduction in all-cause pharmacy cost compared with either DOAC.
The authors of this study have nothing to disclose.</abstract><cop>United States</cop><pub>Academy of Managed Care Pharmacy</pub><pmid>36282935</pmid><doi>10.18553/jmcp.2022.28.11.1304</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2376-0540 |
| ispartof | Journal of managed care & specialty pharmacy, 2022-11, Vol.28 (11), p.1304-1315 |
| issn | 2376-0540 2376-1032 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10372967 |
| source | MEDLINE; PubMed Central |
| subjects | Administration, Oral Anticoagulants - adverse effects Atrial Fibrillation - complications Atrial Fibrillation - drug therapy Hemorrhage Humans Infant Insurance Claim Review Pulmonary Embolism - chemically induced Pulmonary Embolism - complications Pulmonary Embolism - prevention & control Pyridones - adverse effects Retrospective Studies Rivaroxaban - adverse effects Stroke - etiology Stroke - prevention & control Venous Thromboembolism - prevention & control Warfarin - adverse effects |
| title | Comparison of real-world clinical and economic outcomes in patients receiving oral anticoagulants: A retrospective claims analysis |
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