title: Is Rivaroxaban Associated With Shorter Hospital Stays and Reduced Costs Versus Parenteral Bridging to Warfarin Among Patients With Pulmonary Embolism?
abstract: OBJECTIVE
  We sought to compare the length of stay (LOS) and total costs for patients with pulmonary embolism (PE) treated with either rivaroxaban or parenterally bridged warfarin.
  
  
  METHODS
  This retrospective claims analysis was performed in the Premier Database from November 2012 to March 2015. Adult patients were included if they had a hospital encounter for PE (an International Classification of Diseases, Ninth Revision code = 415.1×) in the primary position, a claim for ≥1 diagnostic test for PE on day 0 to 2, and initiated rivaroxaban or parenteral anticoagulation/warfarin. Rivaroxaban users (allowing ≤2 days of prior parenteral therapy) were 1:1 propensity score matched to patients receiving parenterally bridged warfarin. Length of stay, total costs, and readmission for venous thromboembolism (VTE) or major bleeding during the same or subsequent 2 months following the index event were compared between cohorts. Analysis restricted to patients with low-risk PE was also performed.
  
  
  RESULTS
  Characteristics of the matched PE cohorts (n = 3466 per treatment) were well balanced. Rivaroxaban use was associated with a 1.36-day shorter LOS and $2304 reduction in total costs compared to parenterally bridged warfarin ( P < .001 for both). Rates of readmission for VTE were similar between cohorts (1.7% vs 1.6%; P = .64). No difference was observed between treatments for readmission for major bleeding (0.2% vs 0.2%; P > .99). In analyses restricted to low-risk patients (n = 1551 per treatment), rivaroxaban was associated with a 1.01-day and a $1855 reduction in LOS and costs, respectively ( P < .001 for both). Rates of readmission were again similar between treatments ( P > .56 for all).
  
  
  CONCLUSIONS
  Rivaroxaban significantly reduced hospital LOS and costs compared to parenterally bridged warfarin, without increasing the risk of readmission.
authors.affiliation: 1 School of Pharmacy, University of Connecticut, Storrs, CT, USA.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
authors.affiliation: 2 Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fermann
authors.affiliation: 1 School of Pharmacy, University of Connecticut, Storrs, CT, USA.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Weeda
authors.affiliation: 3 Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
authors.affiliation: 4 Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Veronica
authors.initials: V
authors.lastname: Ashton
authors.affiliation: 4 Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Concetta
authors.initials: C
authors.lastname: Crivera
authors.affiliation: 5 New England Health Analytics, LLC, Granby, CT, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Bunz
authors.affiliation: 4 Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Wildgoose
authors.affiliation: 4 Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Schein
authors.affiliation: 6 Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000191:economics / Q000627:therapeutic use*; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014859:Warfarin; D000069552:Rivaroxaban
keywords: anticoagulation; bridging therapy; pulmonary embolism; rivaroxaban; warfarin