title: Comparison of differences in medical costs when new oral anticoagulants are used for the treatment of patients with non-valvular atrial fibrillation and venous thromboembolism vs warfarin or placebo in the US.
abstract: OBJECTIVE
  Medical costs that may be avoided when any of the four new oral anticoagulants (NOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, are used instead of warfarin for the treatment of non-valvular atrial fibrillation (NVAF) were estimated and compared. Additionally, the overall differences in medical costs were estimated for NVAF and venous thromboembolism (VTE) patient populations combined.
  
  
  METHODS
  Medical cost differences associated with NOAC use vs warfarin or placebo among NVAF and VTE patients were estimated based on clinical event rates obtained from the published trial data. The clinical event rates were calculated as the percentage of patients with each of the clinical events during the trial periods. Univariate and multivariate sensitivity analyses were conducted for the medical-cost differences determined for NVAF patients. A hypothetical health plan population of 1 million members was used to estimate and compare the combined medical-cost differences of the NVAF and VTE populations and were projected in the years 2015-2018.
  
  
  RESULTS
  In a year, the medical-cost differences associated with NOAC use instead of warfarin were estimated at -$204, -$140, -$495, and -$340 per patient for dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. In 2014, among the hypothetical population, the medical-cost differences were -$3.7, -$4.2, -$11.5, and -$6.6 million for NVAF and acute VTE patients treated with dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. In 2014, for the combined NVAF, acute VTE, and extended VTE patient populations, medical-cost differences were -$10.0, -$10.9, -$21.0, and -$21.0 million for dabigatran, rivaroxaban, 2.5 mg apixaban, and 5 mg apixaban, respectively. Medical-cost differences associated with use of NOACs were projected to steadily increase from 2014 to 2018.
  
  
  CONCLUSIONS
  Medical costs are reduced when NOACs are used instead of warfarin/placebo for the treatment of NVAF or VTE, with apixaban being associated with the greatest reduction in medical costs.
authors.affiliation: University of California , Irvine, CA , USA.
authors.forename: Alpesh
authors.initials: A
authors.lastname: Amin
authors.forename: Amanda
authors.initials: A
authors.lastname: Bruno
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Trocio
authors.forename: Jay
authors.initials: J
authors.lastname: Lin
authors.forename: Melissa
authors.initials: M
authors.lastname: Lingohr-Smith
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D000069604:Dabigatran / Q000191:economics / Q000627:therapeutic use; D005102:Health Expenditures; D006470:Hemorrhage / Q000191:economics; D006801:Humans; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000191:economics; D011655:Pulmonary Embolism / Q000191:economics; D011720:Pyrazoles / Q000191:economics / Q000627:therapeutic use; D011725:Pyridines / Q000191:economics / Q000627:therapeutic use; D011728:Pyridones / Q000191:economics / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000191:economics / Q000627:therapeutic use; D020521:Stroke / Q000191:economics; D013844:Thiazoles / Q000191:economics / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000188:drug therapy*; D014859:Warfarin / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban
keywords: Economic model; Healthcare costs; New oral anticoagulants; Non-valvular atrial fibrillation; Venous thromboembolism