Health Care Resource Utilization, Costs, and Persistence in Patients Newly Diagnosed as Having Nonvalvular Atrial Fibrillation and Newly Treated With Dabigatran versus Warfarin in the United States

• Published in: Clinical therapeutics Vol. 38; no. 3; pp. 545 - 556.e6
• Main Authors: Bancroft, Tim, PhD, Lim, Jonathan, MSc, MEng, Wang, Cheng, MD, PhD, Sander, Stephen D., PharmD, Swindle, Jason P., PhD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016; Elsevier Limited
• Subjects: Administrative Claims, Healthcare - statistics & numerical data; Aged; Aged, 80 and over; Ambulatory Care - utilization; Anticoagulants; Anticoagulants - economics; Anticoagulants - therapeutic use; Atrial Fibrillation - drug therapy; Atrial Fibrillation - economics; Cardiac arrhythmia; dabigatran; Dabigatran - economics; Dabigatran - therapeutic use; Drug Costs - statistics & numerical data; Emergency Service, Hospital - utilization; Female; health care costs; health care resource use; Health Resources - economics; Health Resources - utilization; Humans; Internal Medicine; Male; Medical Education; Medicare; Middle Aged; Office Visits - utilization; persistence; Prescription drugs; Propensity Score; Retrospective Studies; Stroke; United States; warfarin; Warfarin - economics; Warfarin - therapeutic use; United States > US; dabigatran; persistence; health care resource use; health care costs; warfarin
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2016.01.008

Abstract Purpose This study compared health care resource utilization (HCRU), costs, and persistence among patients newly diagnosed as having nonvalvular atrial fibrillation (NVAF) and newly treated with dabigatran versus warfarin. Methods This retrospective claims-based study used data from a large US managed care organization. The earliest claim for dabigatran or warfarin during October 1, 2010 through October 31, 2011 was the index date, with cohort assignment based on index medication. Evidence of newly diagnosed NVAF within 30 days before the index date and no claims for oral anticoagulants during the 12-month preindex period were required. Cohorts were matched using propensity scores. Per-patient-per-month HCRU, costs, and persistence were calculated during the variable follow-up period of up to 12 months after the index date. Descriptive and multivariable analyses were used to examine differences in outcomes. Findings After matching, 869 patients per cohort were identified (mean age, 67.8 years; 40.4% female). Compared with warfarin, dabigatran had fewer per-patient-per-month emergency department (0.10 vs 0.13, P = 0.010), office (1.98 vs 2.96, P < 0.001), and outpatient (1.05 vs 1.48, P < 0.001) visits. Despite higher mean pharmacy costs for dabigatran ( P < 0.001), mean total health care ( P = 0.309) and medical costs ( P = 0.568) were similar to warfarin. Persistence was higher with dabigatran versus warfarin (median, 204 vs 161 days; mean, 213.7 vs 195.5 days, P = 0.001). Implications Among patients newly diagnosed as having NVAF, those newly treated with dabigatran had lower HCRU, higher persistence, and similar total health care costs compared with those treated with warfarin.