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Published on: February 26, 2013
Incremental economic burden associated with major bleeding among atrial fibrillation patients treated with factor Xa
Steven Deitelzweig1, W Richey Neuman2, Melissa Lingohr-Smith3
1a Ochsner Clinic Foundation, Department of Hospital Medicine and The University of Queensland School of Medicine, Ochsner Clinical School , New Orleans , LA , USA.
Insights
Major bleeding events in atrial fibrillation patients treated with factor Xa inhibitors lead to substantial healthcare costs. Managing bleeding complications is crucial for reducing the economic burden in these patients.
Area of Science:
- Pharmacoeconomics
- Cardiology
- Health Services Research
Background:
- Atrial fibrillation (AF) patients often require anticoagulation therapy, with factor Xa inhibitors being a common choice.
- Major bleeding (MB) is a significant complication associated with anticoagulation, impacting patient outcomes and healthcare resource utilization.
- Understanding the economic burden of MB in AF patients is essential for effective healthcare management.
Purpose of the Study:
- To evaluate healthcare resource use and costs associated with major bleeding (MB) in atrial fibrillation (AF) patients treated with factor Xa inhibitors.
- To compare the economic impact of MB hospitalizations and subsequent healthcare costs in AF patients on factor Xa inhibitors.
Main Methods:
- Retrospective analysis of a large claims database (MarketScan, 2011-2014) including AF patients with MB hospitalization.
- Inclusion criteria: AF diagnosis, MB hospitalization, and prior prescription of rivaroxaban or apixaban.
- Comparison group: AF patients on factor Xa inhibitors without MB hospitalization.
Main Results:
- 3.3% of AF patients on factor Xa inhibitors experienced MB (n=3,081).
- Index MB hospitalizations averaged 5.3 days with costs of $28,059.
- Total 1-year healthcare costs were significantly higher for patients with MB ($63,866) versus without MB ($37,916).
Conclusions:
- Major bleeding events in AF patients treated with factor Xa inhibitors represent a substantial economic burden.
- The incremental healthcare costs within one year following MB hospitalization are significant.
- Optimizing care for AF patients experiencing MB may alleviate the associated economic impact.
Objective:
To evaluate healthcare resource use and costs incurred during, as well as following hospitalization for major bleeding (MB), among atrial fibrillation (AF) patients treated with factor Xa inhibitors Methods: Patients with an AF diagnosis and MB hospitalization (index event) were identified from the MarketScan Commercial and Medicare databases (January 1, 2011-December 31, 2014). Patients were required to have ≥1 prescription for rivaroxaban or apixaban within 3 months prior to MB hospitalization. AF patients treated with Xa inhibitors, but who did not have any diagnosis of MB during the study period were identified. Hospital resource use and costs were evaluated for index MB hospitalizations. Healthcare resource use and associated costs were also evaluated for up to 12 months and compared between AF patients with and without MB.
Results:
Of the overall patient population with AF treated with factor Xa inhibitors (n = 92,949), 3,081 (3.3%) were identified as patients with MB and 89,868 without MB. The mean hospital length of stay and hospital cost for index MB hospitalizations were 5.3 days and $28,059, respectively. Total all-cause healthcare costs were higher during the 12 months of follow-up for AF patients with MB vs without ($63,866 vs $37,916, p < .001). After adjusting for differences in patient characteristics, mean total healthcare costs were estimated at $58,169 for patients with MB vs $41,241 for patients without MB.
Limitations:
Since this was an observational study using a claims database analysis, a causal relationship between factor Xa inhibitor treatment and MB events cannot be inferred from the results of this study.
Conclusion:
In the real-world setting, the cost of initial hospitalizations for MB was substantial, and the incremental burden of total healthcare costs within 1 year following MB hospitalization was high. Approaches to better manage the continuum of care of AF patients with factor Xa inhibitor-associated MB may reduce the healthcare economic burden.
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