Abstract 17298: Real-world Evaluation of Healthcare Resource Use and Costs of Elderly Patients With Nonvalvular Atrial Fibrillation Treated With Apixaban vs. Warfarin in the US
Introduction: The impact of apixaban vs. warfarin usage on healthcare resource use (HRU) and associated costs among elderly patients with nonvalvular atrial fibrillation (NVAF) is not well known in the real-world setting.
Hypothesis: The objectives of this study were to evaluate whether differences exist in HRU and costs among elderly NVAF patients treated with apixaban vs. warfarin in the US.
Methods: Patients (≥65 years of age) initiating apixaban or warfarin (index event) were identified from the Humana database (1/1/2013-9/30/2015). Patients were required to have an NVAF diagnosis and 12 months of continuous health plan enrollment (baseline period) prior to the index event date. Patient characteristics were evaluated during the baseline period. Propensity score matching (PSM) was conducted. HRU and costs in the follow-up period were compared between patients receiving apixaban vs. warfarin.
Results: Of the pre-matched population, 7,443 (mean age: 77.8 years) were treated with apixaban and 12,392 (mean age: 78.1 years) treated with warfarin. Mean Charlson Comorbidity Index (CCI, 2.7 vs. 3.0, p<0.001), CHADS2 score (2.6 vs. 2.7, p<0.001), CHADS2-VASc score (4.4 vs. 4.6, p<0.001), and HAS-BLED score (2.9 vs. 3.0, p<0.001) were lower for NVAF patients receiving apixaban vs. warfarin. By implementing PSM, 14,154 patients were matched, with 7,077 in each cohort. Mean ages, CCI score, and stroke and bleeding risks were similar between matched cohorts. Compared to warfarin, apixaban treatment was associated with significantly higher pharmacy costs, but lower inpatient, outpatient, and total all-cause HRU and costs, as well as lower inpatient and total medical HRU and costs associated with major bleeding (table).
Conclusions: In the real-world setting after controlling for differences in patient characteristics, apixaban vs. warfarin usage is generally associated with lower HRU and costs for all causes and bleeding-related services among elderly NVAF patients.
Author Disclosures: S. Deitelzweig: Consultant/Advisory Board; Significant; Bristol-Myers Squibb, Pfizer. X. Luo: Employment; Significant; Pfizer. K. Gupta: Employment; Significant; Bristol-Myers Squibb. J. Trocio: Employment; Significant; Pfizer. J. Mardekian: Employment; Significant; Pfizer. M. Lingohr-Smith: Employment; Significant; Novosys Health. B. Menges: Employment; Significant; Novosys Health. J. Lin: Employment; Significant; Novosys Health. Consultant/Advisory Board; Significant; Bristol-Myers Squibb, Pfizer.
- © 2016 by American Heart Association, Inc.