title: Healthcare utilization and costs associated with dabigatran compared to warfarin treatment in newly diagnosed patients with non-valvular atrial fibrillation.
abstract: OBJECTIVE
  Real-world healthcare resource utilization and costs were compared among patients with non-valvular atrial fibrillation (NVAF) receiving either dabigatran or warfarin.
  
  
  METHODS
  A retrospective cohort study was conducted using administrative claims data from the United States Department of Defense (DOD) Military Health System. Patients with newly diagnosed AF initiated on dabigatran or warfarin were identified using ICD-9 diagnosis, procedure and drug codes. Patients were observed for 3 months prior to treatment initiation to ascertain a diagnosis of valvular heart disease and 12 months for exclusion of those with a history of anticoagulation therapy. Propensity score matching was used to balance baseline characteristics between the two treatment cohorts. Medical and pharmacy utilization and costs were compared between the dabigatran and warfarin treatment groups for 3 and 12 months following treatment initiation.
  
  
  RESULTS
  A total of 1102 patients with newly diagnosed NVAF initiated on dabigatran were matched with corresponding warfarin-treated patients. In the 12 months following initiation of anticoagulation, the mean medical costs for patients initiated on dabigatran were significantly lower than for patients initiated on warfarin (-$6299, p < 0.001), largely due to fewer hospitalizations (-0.162, p = 0.009). While pharmacy costs were higher ($4369, p < 0.001) for dabigatran, overall healthcare costs were significantly lower compared with patients on warfarin (12 months: -$1940, p < 0.001). Mean hospital length of stay between these two groups were similar (6.033 days for dabigatran vs 6.318 days for warfarin, p = 0.139).
  
  
  CONCLUSIONS
  Despite higher pharmacy costs for NVAF patients initiated on dabigatran vs warfarin, this was more than offset by lower utilization of medical care resources.
authors.affiliation: a a Trinity Partners , Waltham , MA , USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Francis
authors.affiliation: a a Trinity Partners , Waltham , MA , USA.
authors.forename: Chen
authors.initials: C
authors.lastname: Yu
authors.affiliation: a a Trinity Partners , Waltham , MA , USA.
authors.forename: Hasmik
authors.initials: H
authors.lastname: Alvrtsyan
authors.affiliation: b b Boehringer Ingelheim Pharmaceuticals Inc. , Ridgefield , CT , USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sander
authors.affiliation: b b Boehringer Ingelheim Pharmaceuticals Inc. , Ridgefield , CT , USA.
authors.forename: Sabyasachi
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: a a Trinity Partners , Waltham , MA , USA.
authors.forename: Yajing
authors.initials: Y
authors.lastname: Rao
authors.affiliation: a a Trinity Partners , Waltham , MA , USA.
authors.forename: Herman
authors.initials: H
authors.lastname: Sanchez
authors.affiliation: c c Program in Health Services and Systems Research, Duke-NUS Graduate Medical School , Singapore , The Republic of Singapore.|d d Department of Medicine (General Internal Medicine) , Duke University Medical Center , Durham , NC , USA.
authors.forename: David
authors.initials: D
authors.lastname: Matchar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D015331:Cohort Studies; D000069604:Dabigatran / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D057216:Propensity Score; D012189:Retrospective Studies; D014481:United States; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069604:Dabigatran
keywords: Atrial fibrillation; Costs; Dabigatran; Warfarin