title: Costs of hospital visits among patients with deep vein thrombosis treated with rivaroxaban and LMWH/warfarin.
abstract: BACKGROUND
  For many years, the standard of care for patients diagnosed with deep vein thrombosis (DVT) has been low-molecular-weight heparin (LMWH) bridging to an oral Vitamin-K antagonist (VKA). The availability of new non-VKA oral anticoagulants (NOAC) agents as monotherapy may reduce the likelihood of hospitalization for DVT patients.
  
  
  OBJECTIVE
  To compare hospital visit costs of DVT patients treated with rivaroxaban and LMWH/warfarin.
  
  
  METHODS
  A retrospective claim analysis was conducted using the MarketScan Hospital Drug Database for care provided between January 2011 and December 2013. Adult patients using rivaroxaban or LMWH/warfarin with a primary diagnosis of DVT during the first day of a hospital visit were identified (i.e., index hospital visit). Based on propensity-score methods, historical LMWH/warfarin patients (i.e., patients who received LMWH/warfarin before the approval of rivaroxaban) were matched 4:1 to rivaroxaban patients. The hospital-visit cost difference between these groups was evaluated for the index hospital visit, as well as for total hospital-visit costs (i.e., including index and subsequent hospital visit costs).
  
  
  RESULTS
  All rivaroxaban users (n = 134) in the database were well-matched with four LMWH/warfarin users (n = 536). The mean hospital-visit costs were $5257 for the rivaroxaban cohort and $6764 in the matched-cohort of patients using LMWH/warfarin. The $1508 cost difference was statistically significant between cohorts (95% CI = [-$2296; -$580]; p-value = 0.002). Total hospital-visit costs were lower for rivaroxaban compared to LMWH/warfarin users within 1, 2, 3, and 6 months after index visit (significantly lower within 1 and 3 months, p-values <0.05) LIMITATIONS: Limitations were inherent to administrative-claims data, completeness of baseline characteristics, adjustments restricted to observational factors, and lastly the sample size of the rivaroxaban cohort.
  
  
  CONCLUSIONS
  The availability of rivaroxaban significantly reduced the costs of hospital visits in patients with DVT treated with rivaroxaban compared to LMWH/warfarin.
authors.affiliation: a a Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: Geno J
authors.initials: GJ
authors.lastname: Merli
authors.affiliation: a a Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.affiliation: b b Groupe d'analyse , Ltée, Montréal, QC , Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.affiliation: b b Groupe d'analyse , Ltée, Montréal, QC , Canada.
authors.forename: François
authors.initials: F
authors.lastname: Laliberté
authors.affiliation: c c Janssen Scientific Affairs , LLC , Raritan , NJ , USA.
authors.forename: Monika K
authors.initials: MK
authors.lastname: Raut
authors.affiliation: b b Groupe d'analyse , Ltée, Montréal, QC , Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Germain
authors.affiliation: c c Janssen Scientific Affairs , LLC , Raritan , NJ , USA.
authors.forename: Brahim
authors.initials: B
authors.lastname: Bookhart
authors.affiliation: a a Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000191:economics* / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000191:economics* / Q000627:therapeutic use; D012737:Sex Factors; D012959:Socioeconomic Factors; D020246:Venous Thrombosis / Q000188:drug therapy*; D014859:Warfarin / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D000069552:Rivaroxaban
keywords: Costs; Deep vein thrombosis; Hospitalization; Non-vitamin-K antagonist oral anticoagulant