Cost Avoidance Associated with Aspirin De-Prescribing Among Patients Receiving Warfarin

From 2017 to 2018, the Michigan Anticoagulation Quality Improvement Initiative (MAQI ² ) sought to improve guideline-concordant aspirin use among warfarin-treated patients through a multicenter quality improvement initiative. The cost savings of this intervention are unknown.

To determine the amount reimbursed from insurance for bleeding and thrombotic events; to estimate the reimbursement savings from our antithrombotic stewardship intervention in US dollars.

Insurance claims data were linked to the MAQI ² cohort data in conjunction with the Michigan Value Collaborative. Emergency department or inpatient claims were included. Total reimbursed facility or professional payments were aggregated, with categories with low events excluded to ensure confidentiality. We calculated clinical outcome event rates pre/postintervention, and the median and interquartile range (IQR) of dollars reimbursed for each event. Estimated reimbursement savings per 100-patient-years of follow-up were calculated based on pre/postintervention event rates.

Major bleeding events were associated with a median inpatient/emergency department (ED) cost of $13,661 (IQR: $6,601). Nonmajor bleeding events had a median inpatient cost of $11,678 (IQR: $6,050) and a median ED cost of $457 (IQR: $517). Major bleeding events were reduced by 1.3 bleeds per 100-patient-years postintervention for a savings of $17,759 per 100-patient-years. Nonmajor bleeding was reduced by 8.5 bleeds per 100-patient-years postintervention, for a savings of $26,535 per 100-patient-years. Thrombosis rates were similar pre- and postintervention. Overall estimated savings are $44,294 per 100-patient years or $443 per patient annually.

Our antithrombotic stewardship intervention was associated with healthcare system payment savings and improved patient outcomes.