Comparison of differences in medical costs when new oral anticoagulants are used for the treatment of patients with non-valvular atrial fibrillation and venous thromboembolism vs warfarin or placebo in the US.
OBJECTIVE
Medical costs that may be avoided when any of the four new oral anticoagulants (NOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, are used instead of warfarin for the treatment of non-valvular atrial fibrillation (NVAF) were estimated and compared. Additionally, the overall differences in medical costs were estimated for NVAF and venous thromboembolism (VTE) patient populations combined.


METHODS
Medical cost differences associated with NOAC use vs warfarin or placebo among NVAF and VTE patients were estimated based on clinical event rates obtained from the published trial data. The clinical event rates were calculated as the percentage of patients with each of the clinical events during the trial periods. Univariate and multivariate sensitivity analyses were conducted for the medical-cost differences determined for NVAF patients. A hypothetical health plan population of 1 million members was used to estimate and compare the combined medical-cost differences of the NVAF and VTE populations and were projected in the years 2015-2018.


RESULTS
In a year, the medical-cost differences associated with NOAC use instead of warfarin were estimated at -$204, -$140, -$495, and -$340 per patient for dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. In 2014, among the hypothetical population, the medical-cost differences were -$3.7, -$4.2, -$11.5, and -$6.6 million for NVAF and acute VTE patients treated with dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. In 2014, for the combined NVAF, acute VTE, and extended VTE patient populations, medical-cost differences were -$10.0, -$10.9, -$21.0, and -$21.0 million for dabigatran, rivaroxaban, 2.5 mg apixaban, and 5 mg apixaban, respectively. Medical-cost differences associated with use of NOACs were projected to steadily increase from 2014 to 2018.


CONCLUSIONS
Medical costs are reduced when NOACs are used instead of warfarin/placebo for the treatment of NVAF or VTE, with apixaban being associated with the greatest reduction in medical costs.
['Amin|Alpesh|A|', 'Bruno|Amanda|A|', 'Trocio|Jeffrey|J|', 'Lin|Jay|J|', 'Lingohr-Smith|Melissa|M|']
D000925:Anticoagulants D001281:Atrial Fibrillation D003362:Cost-Benefit Analysis D003365:Costs and Cost Analysis D000069604:Dabigatran D005102:Health Expenditures D006470:Hemorrhage D006801:Humans D017059:Models, Econometric D009203:Myocardial Infarction D011655:Pulmonary Embolism D011720:Pyrazoles D011725:Pyridines D011728:Pyridones D000069552:Rivaroxaban D020521:Stroke D013844:Thiazoles D014481:United States D054556:Venous Thromboembolism D014859:Warfarin
New oral anticoagulants Non-valvular atrial fibrillation Venous thromboembolism Economic model Healthcare costs