Health Care Resource Utilization and Costs Among Newly Diagnosed and Oral Anticoagulant-Naive Nonvalvular Atrial Fibrillation Patients Treated with Dabigatran or Warfarin in the United States

• DOI: 10.18553/jmcp.2018.24.1.73
• Publication Date: 2017-12-30T13:35:21Z
• Authors: Rahul Jain; An-Chen Fu; Jonathan Lim; Cheng Wang; Jessica Elder; Stephen D. Sander; Hiangkiat Tan
• Keywords: Stroke

Warfarin has a long history of use to reduce the risk stroke in patients with atrial fibrillation (AF), but it requires frequent laboratory monitoring maintain international normalized ratio levels therapeutic range. Dabigatran, novel oral anticoagulant (OAC), demonstrated efficacy reducing and systemic embolism does not require monitoring.To compare health care resource utilization (HCRU) costs OAC-naive newly diagnosed nonvalvular (NVAF), using dabigatran or warfarin.This retrospective observational study used data from medical pharmacy claims extracted HealthCore Integrated Research Database representing commercial Medicare Advantage members. Adults aged > 18 years diagnosis claim NVAF were identified between October 1, 2010, December 31, 2011. The date first observed OAC prescription was index date. Patients followed for up 12 months after assigned warfarin treatment groups based on their fills. To potential selection bias, cohorts matched baseline characteristics propensity score matching. HCRU measured compared per-patient-per-month (PPPM) basis all-cause HCRU, as well stroke, myocardial infarction, bleed-specific HCRU. Pharmacy, medical, total also adjusted 2012 U.S. dollars. Generalized linear models conducted cohorts.After matching, 1,648 included analysis (824 each groups). In post-index period, group had significantly fewer PPPM physician office visits (mean [SD] 1.29 [± 0.95] vs. 2.02 1.53], P < 0.001) outpatient 2.17 2.90] 3.52 3.32], those group. There no between-group differences outcomes number bleeding-related visits. All-cause cohort lower than cohort; however, difference did reach statistical significance ($2,696 [SD ± $6,699] $2,893 $6,819], = 0.179). higher versus ($455 $429] $328 $517], 0.001). stroke-related ($32 $71] $20 $55], 0.006) nonstroke-related ($423 $422] $308 $515], Despite cohort, both statistically similar ($3,151 $6,744] $3,221 $6,869], 0.701).This real-world showed that among who naive, associated less terms pharmaceutical follow-up. Similar other studies, this research supports finding users offset by costs, making comparable work supported Boehringer Ingelheim Pharmaceuticals, which is manufacturer dabigatran, one products work. authors responsible all content editorial decisions. Jain Tan are employed HealthCore, consultancy funded Pharmaceuticals study. Fu at time Lim, Wang, Elder, Sander employees Pharmaceuticals. Study concept design contributed Sander, Tan, along Jain. Fu, collected data, interpretation performed Jain, Fu. manuscript written Lim revised Tan. Some results presented Quality Care Outcomes Cardiovascular Disease Stroke (QCOR) 2014 Scientific Sessions June 2-4, 2014, Baltimore, Maryland.