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Comparison of Healthcare Resource Utilization and Costs between Rivaroxaban and Warfarin for Nonvalvular Atrial Fibrillation in a Skilled Nursing Facility Setting

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Abstract

Background

Use of direct-acting oral anticoagulants for patients with nonvalvular atrial fibrillation (NVAF) in skilled nursing facilities (SNFs) is increasing. Rivaroxaban is commonly used in this setting as an alternative to warfarin, based on comparable or increased efficacy in preventing stroke and a similar or lower risk of major bleeding.

Objective

The aim of this study was to compare healthcare resource utilization (HCRU) and costs between NVAF patients receiving rivaroxaban or warfarin in SNFs.

Methods

This retrospective study examined de-identified claims from Optum® Clinformatics® Extended Data Mart (1 January 2013–31 December 2017). Eligible patients had an AF diagnosis, were prescribed rivaroxaban or warfarin during an SNF stay, and had one or more such prescriptions filled in the 6 months preceding the stay. Patients were excluded if they received another oral anticoagulant or had evidence of valvular heart disease, mitral stenosis, or organ/tissue transplant. HCRU, mean number of events, and all-cause healthcare costs during the index SNF stay were reported. Results were also reported on a per-patient-per-month (PPPM) basis. Exploratory analyses at different time periods were also conducted.

Results

Overall, 4423 rivaroxaban patients and 22,796 warfarin patients were identified prior to inverse probability of treatment weighting adjustment. Index SNF stay was significantly shorter among rivaroxaban-treated patients (35.8 ± 35.8 days) versus warfarin (40.1 ± 46.3 days; p < 0.0001). During the SNF stay, overall HCRU was lower for the rivaroxaban cohort versus the warfarin cohort. All-cause total costs were significantly reduced for rivaroxaban ($6450 ± $10,379) versus warfarin ($7640 ± $16,556; p < 0.0001), and similar results were observed when calculated on a PPPM basis. During the 1-year post-index period, PPPM all-cause total costs were significantly lower with rivaroxaban versus warfarin ($4135 vs. $4561; p < 0.0001).

Conclusion

In this SNF setting, HCRU and costs were lower among patients with NVAF who were experienced users of rivaroxaban compared with those who were experienced users of warfarin. These findings may help inform clinical decision making to reduce the economic burden of NVAF among older adults in SNFs.

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Authors and Affiliations

  1. University of Illinois at Chicago and Advocate Illinois Masonic Medical Center, Melrose Park, IL, USA

    Dheeraj Mahajan

  2. Janssen Scientific Affairs, LLC, Titusville, NJ, USA

    Bingcao Wu, Ji Song, Dejan Milentijevic & Veronica Ashton

  3. CMO, Advanced Health Institute and LTC Professionals, Bloomington, MN, USA

    V. Simon Mittal

  4. University of Illinois at Chicago, Advocate Illinois Masonic Medical Center, 101 Madison Street, Suite 300, Oak Park, IL, 60302, USA

    Dheeraj Mahajan

Authors
  1. Dheeraj Mahajan
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  2. Bingcao Wu
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  3. Ji Song
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  4. Dejan Milentijevic
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Corresponding author

Correspondence to Dheeraj Mahajan.

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Conflict of interest

V. Simon Mittal and Dheeraj Mahajan have no conflicts of interest to declare. Bingcao Wu, Ji Song, Dejan Milentijevic, and Veronica Ashton are full-time employees of Janssen Scientific Affairs, LLC.

Funding

This study was funded by Janssen Scientific Affairs, LLC (Titusville, NJ, USA). Medical writing support was provided by Alaina Mitsch, PhD, of MedErgy (Yardley, PA, USA), and was funded by Janssen Scientific Affairs, LLC.

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Mahajan, D., Wu, B., Song, J. et al. Comparison of Healthcare Resource Utilization and Costs between Rivaroxaban and Warfarin for Nonvalvular Atrial Fibrillation in a Skilled Nursing Facility Setting. Drugs Aging 37, 281–289 (2020). https://doi.org/10.1007/s40266-019-00737-x

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  • DOI: https://doi.org/10.1007/s40266-019-00737-x

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