title: Medical costs in the US of clinical events associated with oral anticoagulant (OAC) use compared to warfarin among non-valvular atrial fibrillation patients ≥75 and <75 years of age, based on the ARISTOTLE, RE-LY, and ROCKET-AF trials.
abstract: OBJECTIVE
  Based on clinical trials the oral anticoagulants (OACs) apixaban, dabigatran, and rivaroxaban are efficacious for reducing stroke risk for non-valvular atrial fibrillation (NVAF) patients. Based on the clinical trials, this study evaluated the medical costs for clinical events among NVAF patients ≥75 and <75 years of age treated with individual OACs vs warfarin.
  
  
  METHODS
  Rates for primary and secondary efficacy and safety outcomes (i.e., clinical events) among NVAF patients receiving warfarin or each of the OACs were determined for NVAF populations aged ≥75 years and <75 years of age from the OAC vs warfarin trials. One-year incremental costs among patients with clinical events were obtained from published literature and inflation adjusted to 2010 costs. Medical costs, excluding medication costs, for clinical events associated with each OAC and warfarin were then estimated and compared.
  
  
  RESULTS
  Among NVAF patients aged ≥75, compared to warfarin, use of either apixaban or rivaroxaban was associated with a reduction in medical costs per patient year (apixaban = -$825, rivaroxaban =-$23), while dabigatran use was associated with increased medical costs of $180 per patient year. Among NVAF patients <75 years of age medical costs per patient year were estimated to be reduced -$254, -$367, and -$88, for apixaban, dabigatran, and rivaroxaban, respectively, in comparison to warfarin.
  
  
  CONCLUSIONS
  This economic analysis was based on clinical trial data and, therefore, the direct application of the results to routine clinical practice will require further assessment.
  
  
  CONCLUSIONS
  Difference in medical costs between OAC and warfarin treated NVAF patients vary by age group and individual OACs. Although reductions in medical costs for NVAF patients aged ≥75 and <75 were observed for those using either apixaban or rivaroxaban vs warfarin, the reductions were greater per patient year for both the older and younger NVAF populations using apixaban.
authors.affiliation: Ochsner Clinic Foundation, New Orleans, LA, USA. sdeitelzweig@ochsner.org
authors.forename: Steve
authors.initials: S
authors.lastname: Deitelzweig
authors.forename: Alpesh
authors.initials: A
authors.lastname: Amin
authors.forename: Yonghua
authors.initials: Y
authors.lastname: Jing
authors.forename: Dinara
authors.initials: D
authors.lastname: Makenbaeva
authors.forename: Daniel
authors.initials: D
authors.lastname: Wiederkehr
authors.forename: Jay
authors.initials: J
authors.lastname: Lin
authors.forename: John
authors.initials: J
authors.lastname: Graham
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D001562:Benzimidazoles / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D009025:Morpholines / Q000191:economics / Q000627:therapeutic use; D011720:Pyrazoles / Q000191:economics / Q000627:therapeutic use; D011728:Pyridones / Q000191:economics / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D000069552:Rivaroxaban; D012720:Severity of Illness Index; D020521:Stroke / Q000517:prevention & control*; D013876:Thiophenes / Q000191:economics / Q000627:therapeutic use; D014481:United States; D014859:Warfarin / Q000191:economics* / Q000627:therapeutic use; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran