Patient-reported treatment satisfaction and budget impact with rivaroxaban vs. standard therapy in elective cardioversion of atrial fibrillation: a post hoc analysis of the X-VeRT trial.
OBJECTIVE
We compared patient-reported treatment satisfaction and the economic impact of anticoagulation therapy with rivaroxaban vs. vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation undergoing elective cardioversion procedures.


RESULTS
The current study is a post hoc analysis of the prospective, multicentre X-VeRT (EXplore the efficacy and safety of once-daily oral riVaroxaban for the prevention of caRdiovascular events in subjects with non-valvular aTrial fibrillation scheduled for cardioversion) trial. Patient-reported treatment satisfaction with anticoagulation therapy was assessed using the Treatment Satisfaction Questionnaire for Medication version II in seven countries (US, UK, Canada, Germany, France, Italy, and the Netherlands). An economic model was also developed to estimate the impact of postponed cardioversions for two countries (UK and Italy). This model estimated the total costs of cardioversion, taking into consideration the costs for drug therapy (including extended treatment duration due to cardioversion postponement), international normalized ratio monitoring of VKAs, the cardioversion procedure, and rescheduling the procedure. These costs were linked to the respective X-VeRT study data to estimate the total costs. Patients receiving rivaroxaban in the delayed cardioversion group had significantly higher scores for Convenience, Effectiveness, and Global satisfaction (81.74 vs. 65.78; 39.41 vs. 32.95; and 82.07 vs. 66.74, respectively; P < 0.0001). Based on the total patient population included in the treatment satisfaction substudy (n = 632) in the delayed cardioversion group in X-VeRT, the use of rivaroxaban was estimated to result in a saving of £421 and €360 per patient in UK and Italian settings, respectively.


CONCLUSIONS
The use of rivaroxaban in the setting of cardioversion resulted in greater patient satisfaction and cost savings, compared with that of VKA.
Department of Cardiology, Division of Clinical Electrophysiology, J.W. Goethe University, Frankfurt, Germany hohnloser@em.uni-frankfurt.de.
Stefan H
SH
Hohnloser
Arrhythmia and Electrophysiology Center, IRCCS Humanitas Research Hospital, Milan, Italy Humanitas Gavazzeni Hospital, Bergamo, Italy.
Riccardo
R
Cappato
The Sidney Kimell Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Michael D
MD
Ezekowitz
Bayer Pharma AG, Wuppertal, Germany.
Thomas
T
Evers
ClinStat GmbH, Statistics and Health Economics, Cologne, Germany.
Kurtulus
K
Sahin
Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, University of Birmingham, SWBH and UHB NHS Trusts, Birmingham, UK Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany.
Paulus
P
Kirchhof
Global Medical Affairs, Bayer HealthCare, Berlin, Germany.
Isabelle Ling
IL
Meng
Global Medical Affairs, Bayer HealthCare, Berlin, Germany.
Martin
M
van Eickels
Division of Clinical Sciences, St George's, University of London, London, UK.
A John
AJ
Camm
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D002017:Budgets; D002170:Canada; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004554:Electric Countershock / Q000009:adverse effects / Q000191:economics*; D005060:Europe; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D017060:Patient Satisfaction; D011446:Prospective Studies; D000069552:Rivaroxaban / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D020521:Stroke / Q000191:economics / Q000517:prevention & control; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014812:Vitamin K / Q000037:antagonists & inhibitors; D014859:Warfarin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D014812:Vitamin K; D014859:Warfarin; D000069552:Rivaroxaban
Cardioversion; Costs; Economic analysis; Rivaroxaban; Treatment satisfaction