Key result
Rivaroxaban use in low-risk pulmonary embolism patients was associated with significantly lower 90-day total healthcare costs ($6,270 vs $9,671, p=0.0027) and fewer hospital-acquired complications compared to standard of care.
Why the study?
To evaluate the clinical and economic effectiveness of rivaroxaban compared with standard of care among low-risk pulmonary embolism patients in the Veterans Health Administration.
Does rivaroxaban improve clinical and economic outcomes compared to standard of care in low-risk pulmonary embolism patients?
Cohort (n=256)
Yes
Does rivaroxaban improve clinical and economic outcomes compared to standard of care in low-risk pulmonary embolism patients?
Absolute Event Rate: 6270% vs 9671%
p-value: p=0.0027
In low-risk pulmonary embolism patients, rivaroxaban was associated with lower healthcare costs and fewer hospital-acquired complications compared to standard of care, with similar clinical outcomes.
May reduce costs in low-risk PE; leaves open need for RCTs before practice change.
BackgroundL Rivaroxaban, a fixed-dose oral direct factor Xa inhibitor, does not require continuous monitoring and thus reduces the hospital stay and economic burden in low-risk pulmonary embolism (LRPE) patients. Study Question: What is the effectiveness of rivaroxaban versus the standard of care (SOC; low-molecular-weight heparin, unfractionated heparin, warfarin) among LRPE patients in the Veterans Health Administration? Study Design: Adult patients with continuous health plan enrollment for ≥12 months pre- and 3 months post-inpatient PE diagnosis (index date=discharge date) between October 1, 2011- June 30, 2015 and an anticoagulant claim during the index hospitalization were included. Measures and Outcomes Patients scoring 0 points on the simplified Pulmonary Embolism Stratification Index were considered low-risk and were stratified into SOC and rivaroxaban cohorts. Propensity score matching (PSM) was used to compare hospital-acquired complications (HACs), PE-related outcomes (recurrent venous thromboembolism, major bleeding, and death), and healthcare utilization and costs between the rivaroxaban and SOC cohorts. Results: Among 6746 PE patients, 1918 were low-risk; of these, 73 were prescribed rivaroxaban, 1546 were prescribed SOC, and 299 were prescribed other anticoagulants during the index hospitalization. After 1:3 PSM, 64 rivaroxaban and 192 SOC patients were included. During the index hospitalization, rivaroxaban users (versus SOC) had similar inpatient length of stay (LOS; 7.0 vs 6.7 days, standardized difference [STD]=1.8) but fewer HACs (4.7% vs 10.4%; STD: 21.7). In the 90-day post-discharge period, PE-related outcome rates were similar between the cohorts (all p>0.05). However, rivaroxaban users had fewer outpatient (15.9 vs 20.4; p=0.0002) visits per patient as well as lower inpatient ($765 vs $2,655; p<0.0001), pharmacy ($711 vs $1,086; p=0.0033), and total costs ($6,270 vs $9,671; p=0.0027). Conclusions: LRPE patients prescribed rivaroxaban had similar index LOS and PE-related outcomes, but fewer HACs, and lower total costs than those prescribed SOC.
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Peacock et al. (2023) conducted a cohort in Low-risk pulmonary embolism (n=256). Rivaroxaban vs. Standard of care (low-molecular-weight heparin, unfractionated heparin, warfarin) was evaluated on Total healthcare costs at 90 days (p=0.0027). Rivaroxaban use in low-risk pulmonary embolism patients was associated with significantly lower 90-day total healthcare costs ($6,270 vs $9,671, p=0.0027) and fewer hospital-acquired complications compared to standard of care.
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