title: Hospital length-of-stay and costs among pulmonary embolism patients treated with rivaroxaban versus parenteral bridging to warfarin.
abstract: We sought to compare length-of-stay (LOS), total hospital costs, and readmissions among pulmonary embolism (PE) patients treated with rivaroxaban versus parenterally bridged warfarin. We identified adult PE (primary diagnostic code = 415.1x) patients in the Premier Database (11/2012-9/2015), and included those with ≥1 PE diagnostic test on days 0-2. Rivaroxaban users (allowing ≤2 days of prior parenteral therapy) were 1:1 propensity score matched to patients parenterally bridged to warfarin. LOS, total costs, and readmission for venous thromboembolism (VTE) or major bleeding within the same or subsequent 2 months were compared between cohorts. Separate analyses were performed in low-risk PE patients. Rivaroxaban use was associated with a 1.4-day [95 % confidence interval (CI) -1.47 to -1.28] shorter LOS, and $2322 (95 % CI -$2499 to -$2146) reduction in costs compared to parenterally bridged warfarin (p < 0.001 for both). There was no difference in readmission for VTE (1.5 versus 1.7 %) or major bleeding (0.3 versus 0.2 %) between the rivaroxaban and parenterally bridged warfarin cohorts (p ≥ 0.27 for both). Results were similar in low-risk patients (0.2-1.0 day and $251-$1751 reductions in LOS and costs, respectively, p ≤ 0.01 for all). In patients with PE, rivaroxaban was associated with reduced LOS and costs, without increased risk of readmission versus parenterally bridged warfarin. Similar results were observed in low-risk PE patients.
authors.affiliation: School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Storrs, CT, 06269, USA.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Weeda
authors.affiliation: Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
authors.affiliation: Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fermann
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baugh
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Veronica
authors.initials: V
authors.lastname: Ashton
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Concetta
authors.initials: C
authors.lastname: Crivera
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Wildgoose
authors.affiliation: Janssen Scientific Affairs, LLC, Raritan, NJ, USA.
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Schein
authors.affiliation: School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Storrs, CT, 06269, USA. craig.coleman@hhchealth.org.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D014859:Warfarin / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069552:Rivaroxaban
keywords: Length-of-stay; Parenteral bridging; Pulmonary embolism; Rivaroxaban; Venous thromboembolism