title: Health Care Resource Utilization, Costs, and Persistence in Patients Newly Diagnosed as Having Nonvalvular Atrial Fibrillation and Newly Treated With Dabigatran versus Warfarin in the United States.
abstract: OBJECTIVE
  This study compared health care resource utilization (HCRU), costs, and persistence among patients newly diagnosed as having nonvalvular atrial fibrillation (NVAF) and newly treated with dabigatran versus warfarin.
  
  
  METHODS
  This retrospective claims-based study used data from a large US managed care organization. The earliest claim for dabigatran or warfarin during October 1, 2010 through October 31, 2011 was the index date, with cohort assignment based on index medication. Evidence of newly diagnosed NVAF within 30 days before the index date and no claims for oral anticoagulants during the 12-month preindex period were required. Cohorts were matched using propensity scores. Per-patient-per-month HCRU, costs, and persistence were calculated during the variable follow-up period of up to 12 months after the index date. Descriptive and multivariable analyses were used to examine differences in outcomes.
  
  
  RESULTS
  After matching, 869 patients per cohort were identified (mean age, 67.8 years; 40.4% female). Compared with warfarin, dabigatran had fewer per-patient-per-month emergency department (0.10 vs 0.13, P = 0.010), office (1.98 vs 2.96, P < 0.001), and outpatient (1.05 vs 1.48, P < 0.001) visits. Despite higher mean pharmacy costs for dabigatran (P < 0.001), mean total health care (P = 0.309) and medical costs (P = 0.568) were similar to warfarin. Persistence was higher with dabigatran versus warfarin (median, 204 vs 161 days; mean, 213.7 vs 195.5 days, P = 0.001).
  
  
  CONCLUSIONS
  Among patients newly diagnosed as having NVAF, those newly treated with dabigatran had lower HCRU, higher persistence, and similar total health care costs compared with those treated with warfarin.
authors: Health Economics and Outcomes Research, Inc., Optum, Eden Prairie, Minnesota.
authors: Tim
authors: T
authors: Bancroft
authors: Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut.
authors: Jonathan
authors: J
authors: Lim
authors: Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut.
authors: Cheng
authors: C
authors: Wang
authors: Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut.
authors: Stephen D
authors: SD
authors: Sander
authors: Health Economics and Outcomes Research, Inc., Optum, Eden Prairie, Minnesota. Electronic address: jason.swindle@optum.com.
authors: Jason P
authors: JP
authors: Swindle
mesh_terms: D000067575:Administrative Claims, Healthcare / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics; D000069604:Dabigatran / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D057216:Propensity Score; D012189:Retrospective Studies; D014481:United States; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069604:Dabigatran
keywords: dabigatran; health care costs; health care resource use; persistence; warfarin