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Health Economic Analysis of Rivaroxaban and Warfarin for Venous Thromboembolism Management in Chinese Patients

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Abstract

Purpose

Rivaroxaban, a direct oral anticoagulant, has demonstrated non-inferiority to warfarin for venous thromboembolism (VTE) treatment in clinical trials. This study aimed to analyze the direct medical costs for VTE management with rivaroxaban versus warfarin in Hong Kong Chinese patients.

Methods

In this retrospective observational study, VTE patients admitted to the Princess Margaret Hospital from March 2012 to February 2017 who were initiated and discharged with either rivaroxaban or warfarin were included. Patient demographic and clinical data, and healthcare resource utilization for VTE management were collected for the VTE index admission and 1-year post-discharge period.

Results

A total of 181 patients (90 in the rivaroxaban group; 91 in the warfarin group) were included. The mean (± SD) length of stay (LOS) was 4.8 ± 2.7 days and 8.0 ± 3.0 days in the rivaroxaban and warfarin groups, respectively (p > 0.001). The total cost for VTE index admission in the rivaroxaban group was significantly lower than that of the warfarin group (USD 5473 ± 1914 versus USD 3457 ± 1796; p < 0.001) (USD 1 = HKD 7.8). Recurrent VTE and bleeding rates in 1-year post-discharge period were not significantly different between the two groups. The direct total cost of the rivaroxaban group (USD 1271 ± 767) was significantly lower than that of the warfarin group (USD 1739 ± 1045) in 1-year post-discharge period (p < 0.001).

Conclusions

Total direct cost and LOS for VTE admission and total cost in 1-year post-discharge period were significantly lower in patients initiated and discharged with rivaroxaban than those of warfarin.

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References

  1. Law Y, Chan YC, Cheng SWK. Epidemiological updates of venous thromboembolism in a Chinese population. Asian J Surg. 2018;41:176–82.

    Article  Google Scholar 

  2. Cheuk BL, Cheung GC, Cheng SW. Epidemiology of venous thromboembolism in a Chinese population. Br J Surg. 2004;91:424–8.

    Article  CAS  PubMed  Google Scholar 

  3. Einstein Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363:2499–510.

    Article  Google Scholar 

  4. Einstein–PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366:1287–97.

    Article  Google Scholar 

  5. Schulman S, Kakkar AK, Goldhaber SZ, Schellong S, Eriksson H, Mismetti P, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014;129:764–72.

    Article  CAS  PubMed  Google Scholar 

  6. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369:799–808.

    Article  CAS  PubMed  Google Scholar 

  7. Hokusai-VTE Investigators. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013;369:1406–15.

    Article  CAS  Google Scholar 

  8. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315–52.

    Article  PubMed  Google Scholar 

  9. Drug Office, Department of Health, the government of the Hong Kong SAR. Rivaroxaban Website: http://www.drugoffice.gov.hk/eps/drug/productDetail/en/healthcare_providers/104460. Accessed on 28 Jan 2019.

  10. Janssen Pharmaceuticals, Inc. Xarelto Product Package Insert. 2011.

  11. Bellen BV, Bamber L, Carvalho FCD, Prins M, Wang M, Lensing AW. Reduction in the length of stay with rivaroxaban as a single-drug regimen for the treatment of deep vein thrombosis and pulmonary embolism. Curr Med Res Opin. 2014;30:829–37.

    Article  CAS  PubMed  Google Scholar 

  12. Bamber L, Muston D, Mcleod E, Guillermin A, Lowin J, Patel R. Cost-effectiveness analysis of treatment of venous thromboembolism with rivaroxaban compared with combined low molecular weight heparin/vitamin K antagonist. Thromb J. 2015;13:20.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Seaman CD, Smith KJ, Ragni MV. Cost-effectiveness of rivaroxaban versus warfarin anticoagulation for the prevention of recurrent venous thromboembolism: a U.S. perspective. Thromb Res. 2013;132:647–51.

    Article  CAS  PubMed  Google Scholar 

  14. Diken AI, Yalçınkaya A, Hanedan MO, Erol ME, Diken ÖE. Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: a cost analysis. Phlebology. 2018;33:53–9.

    Article  PubMed  Google Scholar 

  15. Coleman CI, Baugh C, Crivera C, Milentijevic D, Wang SW, Lu L, et al. Healthcare costs associated with rivaroxaban or warfarin use for the treatment of venous thromboembolism. J Med Econ. 2017;20:200–3.

    Article  PubMed  Google Scholar 

  16. Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing G-J, Kyrle PA. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost. 2016;14:1480–3.

    Article  CAS  PubMed  Google Scholar 

  17. Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3:692–4.

    Article  CAS  Google Scholar 

  18. Rosendaal F, Cannegieter S, van der Meer F, Briët E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost. 1993;69:236–9.

    Article  CAS  PubMed  Google Scholar 

  19. Margolis JM, Deitelzweig S, Kline J, et al. Shorter hospital stays and lower costs for rivaroxaban compared with warfarin for venous thrombosis admissions. J Am Heart Assoc. 2016;5(10):e003788.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ageno W, Mantovani LG, Haas S, Kreutz R, Monje D, Schneider J, et al. Safety and effectiveness of oral rivaroxaban versus standard anticoagulation for the treatment of symptomatic deep-vein thrombosis (XALIA): an international, prospective, non-interventional study. Lancet Haematol. 2016;3:e12–21.

    Article  PubMed  Google Scholar 

  21. Prins MH, Lensing AW, Bauersachs R, et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thromb J. 2013;11:21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Desai A, Desai A, Calixte R, Aparnath M, Hindenburg A, Salzman S, et al. Comparing length of stay between patients taking rivaroxaban and conventional anticoagulants for treatment of venous thromboembolism. Lung. 2016;194:605–11.

    Article  CAS  PubMed  Google Scholar 

  23. Saint CA, Castelli MR, Crannage AJ, Stacy ZA, Hennessey EK. Comparison of hospital length of stay in patients treated with non–vitamin K oral anticoagulants or parenteral agents plus warfarin for venous thromboembolism. SAGE Open Med. 2017;5:2050312117719628.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Spyropoulos AC, Lin J. Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations. J Manag Care Pharm. 2007;13:475–86.

    PubMed  Google Scholar 

  25. Phillips KW, Ansell J. Outpatient management of oral vitamin K antagonist therapy: defining and measuring high-quality management. Expert Rev Cardiovasc Ther. 2008;6:57–70.

    Article  CAS  PubMed  Google Scholar 

  26. Ho CW, Ho MH, Chan PH, Hai JJ, Cheung E, Yeung CY, et al. Ischemic stroke and intracranial hemorrhage with aspirin, dabigatran, and warfarin: impact of quality of anticoagulation control. Stroke. 2015;46:23–30.

    Article  CAS  PubMed  Google Scholar 

  27. Nordstrom BL, Evans MA, Murphy BR, Nutescu EA, Schein JR, Bookhart BK. Risk of recurrent venous thromboembolism among deep vein thrombosis and pulmonary embolism patients treated with warfarin. Curr Med Res Opin. 2015;31:439–47.

    Article  CAS  PubMed  Google Scholar 

  28. Macedo AF, Bell J, Mccarron C, et al. Determinants of oral anticoagulation control in new warfarin patients: analysis using data from Clinical Practice Research Datalink. Thromb Res. 2015;136:250–60.

    Article  CAS  PubMed  Google Scholar 

  29. Apostolakis S, Sullivan RM, Olshansky B, Lip GY. Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin: the SAMe-TT2R2 score. Chest. 2013;144:1555–63.

    Article  CAS  PubMed  Google Scholar 

  30. Kimmel SE, Chen Z, Price M, Parker CS, Metlay JP, Christie JD, et al. The influence of patient adherence on anticoagulation control with warfarin: results from the International Normalized Ratio Adherence and Genetics (IN-RANGE) study. Arch Intern Med. 2007;167:229–35.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank the critical review of draft manuscript by Mr. Harry Chiu, Ms. Selma Lai, and Mr. William Li of the Pharmacy Department, Princess Margaret Hospital, Hong Kong SAR, China.

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Authors and Affiliations

  1. School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China

    Ka-Po Fung, Kei-Hong Chan & Joyce H. S. You

  2. Pharmacy Department, Princess Margaret Hospital, Hong Kong SAR, China

    Ka-Po Fung, Kei-Hong Chan & Vivien Ng

  3. Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China

    Ping-Tim Tsui

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  1. Ka-Po Fung
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  2. Kei-Hong Chan
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Corresponding author

Correspondence to Joyce H. S. You.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study protocol was approved by Kowloon West Cluster Research Ethics Committee of Hospital Authority prior to the initiation of the study.

Informed Consent

For this retrospective study, formal consent was waived by the Kowloon West Cluster Research Ethics Committee of Hospital Authority.

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Fung, KP., Chan, KH., Ng, V. et al. Health Economic Analysis of Rivaroxaban and Warfarin for Venous Thromboembolism Management in Chinese Patients. Cardiovasc Drugs Ther 33, 331–337 (2019). https://doi.org/10.1007/s10557-019-06872-2

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