A cost-analysis model for anticoagulant treatment in the hospital setting.
BACKGROUND
Rivaroxaban is the first oral factor Xa inhibitor approved in the US to reduce the risk of stroke and blood clots among people with non-valvular atrial fibrillation, treat deep vein thrombosis (DVT), treat pulmonary embolism (PE), reduce the risk of recurrence of DVT and PE, and prevent DVT and PE after knee or hip replacement surgery. The objective of this study was to evaluate the costs from a hospital perspective of treating patients with rivaroxaban vs other anticoagulant agents across these five populations.


METHODS
An economic model was developed using treatment regimens from the ROCKET-AF, EINSTEIN-DVT and PE, and RECORD1-3 randomized clinical trials. The distribution of hospital admissions used in the model across the different populations was derived from the 2010 Healthcare Cost and Utilization Project database. The model compared total costs of anticoagulant treatment, monitoring, inpatient stay, and administration for patients receiving rivaroxaban vs other anticoagulant agents. The length of inpatient stay (LOS) was determined from the literature.


RESULTS
Across all populations, rivaroxaban was associated with an overall mean cost savings of $1520 per patient. The largest cost savings associated with rivaroxaban was observed in patients with DVT or PE ($6205 and $2742 per patient, respectively). The main driver of the cost savings resulted from the reduction in LOS associated with rivaroxaban, contributing to ∼90% of the total savings. Furthermore, the overall mean anticoagulant treatment cost was lower for rivaroxaban vs the reference groups.


CONCLUSIONS
The distribution of patients across indications used in the model may not be generalizable to all hospitals, where practice patterns may vary, and average LOS cost may not reflect the actual reimbursements that hospitals received.


CONCLUSIONS
From a hospital perspective, the use of rivaroxaban may be associated with cost savings when compared to other anticoagulant treatments due to lower drug cost and shorter LOS associated with rivaroxaban.
Janssen Scientific Affairs, LLC , Raritan, NJ , USA.
Samir H
SH
Mody
Lynn
L
Huynh
Daisy Y
DY
Zhuo
Kevin N
KN
Tran
Patrick
P
Lefebvre
Brahim
B
Bookhart
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000191:economics; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000191:economics; D003198:Computer Simulation; D017046:Cost Savings / Q000379:methods / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D018803:Models, Economic; D009025:Morpholines / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D000069552:Rivaroxaban; D013876:Thiophenes / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D014481:United States; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D014859:Warfarin; D000069552:Rivaroxaban
Anticoagulant; Cost-analysis; Economic model; Rivaroxaban