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Situ M, Schwarz UI, Zou G, McArthur E, Kim RB, Garg AX, Sarma S. Does prescribing apixaban or rivaroxaban versus warfarin for patients diagnosed with atrial fibrillation save health system costs? A multivalued treatment effects analysis. Eur J Health Econ 2024; 25:397-409. [PMID: 37195343 DOI: 10.1007/s10198-023-01594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/25/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Non-valvular atrial fibrillation (AF) is a common heart arrhythmia in the elderly population. AF patients are at high-risk of ischemic strokes, but oral anticoagulant (OAC) therapy reduces such risks. Warfarin had been the standard OAC for AF patients, however its effectiveness is highly variable and dependent on close monitoring of the anticoagulant response. Newer OACs such as rivaroxaban and apixaban address these drawbacks but are more costly. It is uncertain which OAC therapy for AF is cost-saving from the healthcare system perspective. METHODS We followed a cohort of patients in Ontario, Canada, aged ≥ 66 who were newly diagnosed with AF and prescribed OACs between 2012 and 2017. We used a two-stage estimation procedure. First, we account for the patient selection into OACs using a multinomial logit regression model and estimated propensity scores. Second, we used an inverse probability weighted regression adjustment approach to determine cost-saving OAC options. We also examined component-specific costs (i.e., drug, hospitalization, emergency department and physician) to understand the drivers of cost-saving OACs. RESULTS We found that compared to warfarin, rivaroxaban and apixaban treatments were cost-saving options, with per-patient 1-year healthcare cost savings at $2436 and $1764, respectively. These savings were driven by cost-savings in hospitalization, emergency department visits, and physician visits, outweighing higher drug costs. These results were robust to alternative model specifications and estimation procedures. CONCLUSIONS Treating AF patients with rivaroxaban and apixaban than warfarin reduces healthcare costs. OAC reimbursement policies for AF patients should consider rivaroxaban or apixaban over warfarin as the first-line treatment.
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Affiliation(s)
- Michael Situ
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1465 Richmond Street, ON, N6G 2M1, London, Canada
| | - Ute I Schwarz
- Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, ON, London, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, ON, London, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1465 Richmond Street, ON, N6G 2M1, London, Canada
- Alimentiv Inc, London, ON, Canada
| | - Eric McArthur
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
| | - Richard B Kim
- Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, ON, London, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, ON, London, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, ON, London, Canada
| | - Amit X Garg
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, ON, London, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1465 Richmond Street, ON, N6G 2M1, London, Canada.
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
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