Objective: To evaluate the incremental economic burden of type 2 diabetes in patients experiencing cardiovascular (CV) hospitalizations. Research design and methods: Adults with >= 1 CV hospitalization were identified using a US-based healthcare claims database from 1 July 2011 to 30 June 2014. Outcomes for patients surviving the index hospitalization were compared between patients with vs. without type 2 diabetes (cohorts were identified in the pre-index period). Subsequent CV hospitalizations were evaluated using Cox proportional hazards models. All-cause and CV-related healthcare resource utilization (HCRU) and costs captured on a per-patient per-month (PPPM) basis during a variable follow-up period were evaluated using appropriate multivariable regression models. Results: Of 316,207 patients with >= 1 CV hospitalization, 23% had comorbid type 2 diabetes. The mean age +/- SD was 62.6 +/- 12.3 years and 64.4% were male. During follow-up, the type 2 diabetes cohort had a 19% higher risk of subsequent CV hospitalizations compared to the non-type-2-diabetes cohort (p <.001). This difference in risk was highest in patients aged 35-44 years. Subsequent all-cause hospitalizations for the type 2 diabetes cohort were longer (mean length of stay, 6.7 vs. 6.3 days; p <.001), with higher total bed-days PPPM (mean, 0.52 vs. 0.43; p <.001), compared to the non-type-2-diabetes cohort. The type 2 diabetes cohort had a significantly higher incremental cost for both the index CV hospitalization (mean cost difference, $1046; p <.001) and all-cause costs PPPM following discharge (mean cost difference, $749; p < .001). Conclusions: Comorbid type 2 diabetes was associated with an increased risk of subsequent CV hospitalizations and higher costs and HCRU during the follow-up period.

Abstract Objectives: To assess the magnitude of difference in all-cause healthcare resource utilization (HCRU) and costs between patients with type 2 diabetes mellitus (T2DM) who died from a cardiovascular disease (CVD)-related cause in the year preceding death vs. those who did not die during this same period. Methods: A large US administrative claims database was used to identify patients with T2DM who died of a CVD-related cause from July 2012 to April 2015. These patients were matched 1:1 to patients with T2DM who did not die, using direct matching methods. HCRU and costs were assessed in each of the four quarters (Q4: 12–10 months; Q3: 9–7 months; Q2: 6–4 months; and Q1: 3–0 months) prior to death and compared between patient cohorts using paired t-tests and McNemar’s tests. Results: A final matched cohort of 7648 patients who died and 7648 patients who did not die were identified. A significantly higher proportion of patients who died utilized inpatient services vs. those who did not die (Q4: 12.6% vs. 4.6%, p < .001; Q3: 14.6% vs. 4.6%, p < .001; Q2: 17.6% vs. 5.5%, p < .001; and Q1: 65.0% vs. 10.1%, p < .001). In addition, patients who died incurred significantly higher all-cause costs (Q4: $8882 vs. $3970, p < .001; Q3: $10,462 vs. $3661, p < .001; Q2: $12,564 vs. $4169, p < .001; and Q1: $36,076 vs. $6319, p < .001). Conclusions: T2DM patients with a CVD-related death had significantly greater HCRU and costs in the year including and preceding death compared to those who did not die.

Objectives: To identify patient characteristics predictive of all-cause healthcare costs among individuals with newly diagnosed non-valvular atrial fibrillation (NVAF) who initiated oral anticoagulant therapy with dabigatran or warfarin. Study Design: Retrospective analysis of administrative claims data of patients with newly diagnosed NVAF. Methods: Dabigatran and warfarin cohorts were identified by first claim (index date) during 10/1/2010 to 11/30/2012. Episode-based costs (all-cause) were determined using Episode Treatment Group (ETG) methodology and computed as per-patient-per-month. Baseline predictors of cost included baseline characteristics and baseline Episode Risk Group (ERG) risk score, which was grouped into 6 categories. To assess cohort differences in subgroups of patients, predictor variables representing the interaction of treatment cohort with patient characteristics were of primary interest. Cost ratios were then computed for subgroups of patients with different characteristics. Results: Cohorts included 4150 dabigatran- and 11,032 warfarin-treated patients. Compared with warfarin, dabigatran patients were younger (mean age: 67.3 vs. 72.5 years; P<0.001) and had lower mean ERG risk scores (4.1 vs. 5.6, P<0.001). Treatment cohort was not a statistically significant predictor of costs. Compared with warfarin, dabigatran was associated with higher cost at ERG risk scores of 2.1 to 4.0 and lower cost at scores of 6.1 to 8.0. Conclusions: Adding to existing evidence that treatment with dabigatran (vs warfarin) for NVAF would not incur higher all-cause healthcare costs, this study found that differences in all-cause healthcare costs did not follow a trend across subgroups of patients with NVAF based on different ERG risk score categories, favoring either therapy.

Factors influencing differences in persistence between dabigatran and warfarin in patients with nonvalvular atrial fibrillation (NVAF) remain unclear. Aim: Compare differences in persistence between new dabigatran and warfarin users in patients newly diagnosed with NVAF, adjusting for sociodemographics, clinical characteristics, patient out-of-pocket cost and other covariates. Methods: A retrospective matched-cohort study was conducted using a US claims database of Medicare and commercially insured patients with NVAF aged≥ 18 years. Persistence and monthly out-of-pocket costs for dabigatran or warfarin were calculated and adjusted for covariates using Cox proportional hazard models. Results & conclusion: Unadjusted persistence was significantly lower among dabigatran users (n = 1025) compared with matched warfarin users (38 vs 46%). Adjusting for covariates rendered this difference insignificant (hazard ratio = 0.930).

Background: While dabigatran has been evaluated in real-world studies compared to warfarin, this is one of the first head-to-head studies that includes a new oral anticoagulant in the comparison of all-cause hospitalization and 30-day readmission. Methods: Adult non-valvular atrial fibrillation (NVAF) patients newly diagnosed and newly treated with dabigatran, rivaroxaban or warfarin were identified within MarketScan claims databases between 10/01/2010-12/31/2014. Patients were continuously enrolled for 12-months prior to index date (first oral anticoagulant claim) and followed for 12 months or until medication switch, discontinuation, inpatient death or end of follow-up. Patients on dabigatran were matched 1:1 to patients on rivaroxaban and separately to patients on warfarin. High and low dose categorization of dabigatran and rivaroxaban were 150mg and 75mg BID and 15 mg and 20 mg QD, respectively. Incidence rate (IR, %) and 95% confidence intervals per 100 person-years for all-cause hospitalization were reported. Hazard ratios (HR) for all-cause hospitalization were estimated with Cox regression, adjusting for demographic and baseline clinical characteristics. Proportion of patients with all-cause 30-day readmission was compared. Results: A total of 26,592 and 33,046 dabigatran patients were matched to rivaroxaban and warfarin patients, respectively (mean age 68 years). Dabigatran patients had an IR for all-cause hospitalization of 41.3, (40.2-42.5) compared to rivaroxaban patients 42.5, (41.4-43.6) and an IR for all-cause hospitalization of 41.6, (40.7-42.6) compared with warfarin patients 45.0, (44.0-46.0). Among low and high dose prescriptions, patients on rivaroxaban and dabigatran had similar IRs of all-cause hospitalization (low dose: 53.8, (50.5-57.0) vs. 52.7, (48.9-56.5) and high dose: 39.1, (37.9-40.3) vs. 39.9. (38.8-41.1)). Cox regression results showed dabigatran patients compared to rivaroxaban patients had a significantly lower risk of all-cause hospitalization compared to warfarin (HR 0.96, p=0.05 and HR 0.93, p<0.001). Significantly fewer dabigatran patients were re-admitted 30-days post-discharge compared to warfarin [17.3% vs. 18.8% (4,201 out of 26,592 and 4,449 out of 26,592), p=0.04]. The proportion of patients with a 30-day readmission was comparable between dabigatran and rivaroxaban [17.2% vs. 18.5% (5,439 out of 33,046 and 5,623 out of 33,046), p=0.10]; however, time post-discharge to readmission was significantly longer for dabigatran patients (8.7 days vs 8.2 days, p=0.013). Conclusions: Adjusted results show dabigatran patients had significantly lower all-cause hospitalization compared to rivaroxaban and warfarin patients. Fewer dabigatran patients experienced a 30-day readmission post-discharge compared to warfarin patients and similar 30-day readmission post-discharge compared to rivaroxaban patients.

OBJECTIVES:With the approval of new non-vitamin K antagonist oral anticoagulants for stroke prevention in non-valvular atrial fibrillation (NVAF), it is anticipated that their introduction may change NVAF treatment patterns; however, there is limited supporting real-world evidence. This study investigated guideline-recommended oral anticoagulation (OAC) treatment and persistence in newly diagnosed patients with NVAF to understand demographic and clinical characteristics. DESIGN:Retrospective observational administrative claims study in the USA. SETTING:Patients with NVAF with ≥1 pharmacy claim for OAC (warfarin, dabigatran, rivaroxaban or apixaban) and no atrial fibrillation diagnosis within 12 months prior to the first claim were identified in the HealthCore Integrated Research Database between 1 November 2010 and 30 November 2013. PARTICIPANTS:45 092 patients with NVAF were included. OUTCOMES:The proportion of OAC-treated patients was stratified by CHADS2 score. Treatment persistence was measured from OAC initiation to discontinuation, end of eligibility or end of study period (30 November 2014), whichever occurred first. RESULTS:Almost half of the patients (41.1%) received an OAC. The proportion treated differed slightly in baseline stroke risk (CHADS2<2: 39.8%; CHADS2=2 or 3: 42.4%; and CHADS2>3: 40.3%: p<0.001). Treated patients were slightly younger (70±12.2 vs 71±14.3 years; p<0.001), more likely male (59.7% vs 52.5%; p<0.001) and had a slightly elevated stroke risk (CHADS2: 2.03±1.3 vs 1.98±1.4; p<0.001) and a lower bleeding risk (HEMORR2HAGES: 2.55±1.8 vs 2.80±1.9; p<0.001) relative to untreated patients. Overall, patients with higher CHADS2 scores had higher HEMORR2HAGES scores. The mean follow-up was 2.25 years (2.25±0.85) and 72.7% of patients discontinued OACs; nearly 25% within 3 months and 55% within 12 months. The mean time to discontinuation was 255±249 days. CONCLUSIONS:The proportion of patients with NVAF who received OAC treatment was lower than previously reported and differed slightly by stroke risk. Patients with an elevated stroke risk had a higher bleeding risk, suggesting that clinicians may incorporate both in the treatment decision.

Background: This is one of the first head-to-head real-world evidence studies comparing stroke-related and bleed-related healthcare and resource utilization (HCRU) and costs among non-valvular atrial fibrillation (NVAF) patients initiating oral anticoagulants. Methods: Adult NVAF patients newly diagnosed and treated with dabigatran, rivaroxaban, or warfarin between 10/01/2010 and 12/31/2014 were identified using MarketScan Commercial and Medicare Supplemental databases. Per-patient-per-month stroke and bleed-related HCRU and costs were reported. Results: Dabigatran patients were matched 1:1 to 26,592 rivaroxaban and 33,024 warfarin patients (mean age=68 years). Compared to rivaroxaban, dabigatran patients had lower bleed-related inpatient and outpatient HCRU (0.004 vs. 0.005; 0.099 vs. 0.145) and significantly lower adjusted bleed-related costs ($116 vs. $172), all p <0.05. Compared to warfarin, dabigatran patients had significantly lower stroke-related outpatient visits (0.034 vs. 0.048, p<0.001) and higher bleed-related outpatient visits (0.101 vs. 0.091, p=0.045). Multivariate adjusted bleed-related costs were significantly lower for dabigatran patients than warfarin patients ($94 vs. $138, p<0.001). Conclusions: The results suggest that dabigatran patients had lower bleed-related HCRU and costs than rivaroxaban patients, and lower outpatient stroke-related HCRU, higher bleed-related outpatient HCRU, and lower bleed-related costs than warfarin patients. It provides valuable stroke-related and bleed-related HCRU and costs information among commercially insured and Medicare patients.

BACKGROUND: Multiple studies have reported that type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular diseases (CVD), and presence of T2DM and CVD increases risk of death. There is growing interest in examining the effects of antidiabetic treatments on the reduction of cardiovascular events in T2DM adults with a history of CVD and thus at higher risk of cardiovascular events. OBJECTIVE: To estimate the incremental all-cause health care utilization and costs among adults with T2DM and a history of CVD compared with adults without a history of CVD, using a national linked electronic medical records (EMR) and claims database. METHODS: Adults aged ≥ 18 years with evidence of at least 1 T2DM-related diagnosis code or antidiabetic medication (date of earliest occurrence was defined as the index date) in calendar year 2012 were identified. The population was divided into 2 cohorts (with and without a history of CVD) and followed until the end of their enrollment coverage, death, or 12 months, whichever came first. Multivariable generalized linear models were used to assess differences in health care utilization and per patient per month (PPPM) total costs (plan- and patient-paid amount for health care services) between the 2 groups during the post-index year, while adjusting for an a priori list of demographic and clinical characteristics. RESULTS: A total of 138,018 adults with T2DM was identified, of which 16,547 (12%) had a history of CVD. The unadjusted resource utilization (outpatient: 27.5 vs. 17.8; emergency room [ER]: 0.8 vs. 0.4; inpatient: 0.4 vs. 0.2 days; and total unique drug prescriptions: 10.1 vs. 8.3) and PPPM total health care costs ($2,655.1 vs. $1,435.0) were significantly higher in T2DM adults with a history of CVD versus T2DM adults without a history of CVD. The adjusted models revealed that T2DM adults with a history of CVD had a 31% higher number of ER visits (rate ratio [RR] = 1.31, 95% CI = 1.25-1.37); 27% more inpatient visits (RR = 1.27, 95% CI = 1.21-1.34); 15% longer mean inpatient length of stay (RR = 1.15, 95% CI = 1.06-1.25); and 11% more outpatient visits (RR = 1.11, 95% CI = 1.09-1.13) compared with T2DM adults without a history of CVD. Furthermore, the difference in total PPPM health care cost was found to be 16% ($200) higher in adults with a history of CVD (RR = 1.16, 95% CI = 1.13-1.19). PPPM costs associated with outpatient and ER visits were approximately 21% and 19% higher among adults with a history of CVD, respectively (P < 0.0001), while costs for inpatient visits were similar between the 2 groups. In addition, a subgroup analysis revealed that adjusted differences in PPPM total cost was larger in the younger age group (56% higher cost in those aged < 45 years) and diminished in the older age group (only 2% higher in those aged ≥ 65 years). CONCLUSIONS: Study findings showed that resource utilization and costs remains significantly higher in T2DM patients with a history of CVD compared with patients without a history of CVD even after controlling for significant patient comorbid and demographic characteristics. Also, younger age groups had higher differences in outcomes compared with older age groups. This study underscores the importance of cost-effective interventions that may reduce economic burden in this T2DM population with a history of CVD. DISCLOSURES: This study was funded by Boehringer Ingelheim. At the time of this study, Mehta and Mountford were employed by IQVIA, which received funding from Boehringer Ingelheim to conduct this study. Mountford is employed by Allergan, which has no connection with this study. Ghosh, Sander, and Kuti are employed by Boehringer Ingelheim. Study concept and design were contributed by Mountford, Mehta, and Ghosh, along with Sander and Kuti. Mountford and Mehta collected the data, and data interpretation was performed by all the authors. The manuscript was written by Sander and Kuti, along with the other authors, and revised by Mehta and Gosh, along with the other authors.

Novel oral anticoagulants (NOAC) such as dabigatran, when compared to warfarin, have been shown to potentially reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF) together with lower healthcare resource utilization (HCRU) and similar total costs. This study expands on previous work by comparing HCRU and costs for patients newly diagnosed with NVAF and newly initiated on dabigatran or warfarin, and is the first study specifically in a Medicare population.

Objectives: Compare costs and healthcare resource utilization (HCRU) among newly-diagnosed non-valvular atrial fibrillation (NVAF) patients newly treated with dabigatran vs apixaban, rivaroxaban, or warfarin. Methods: Newly-diagnosed adult NVAF patients initiating dabigatran, apixaban, rivaroxaban, or warfarin (index event) between October 1, 2010-December 31, 2014 were identified using MarketScan claims data, and followed until medication discontinuation, switch, inpatient death, enrollment end, or study end (December 31, 2015). Dabigatran patients were propensity-score matched 1:1 separately with apixaban, rivaroxaban, and warfarin patients. Per-patient-per-month (PPPM) all-cause cost, HCRU, and 30-day re-admissions were reported. Costs were analyzed using generalized linear models. Results: Final cohorts, each matched with dabigatran patients, included 8,857 apixaban patients, 26,592 rivaroxaban patients, and 33,046 warfarin patients. Dabigatran patients had lower adjusted PPPM total healthcare, inpatient, and outpatient costs compared to rivaroxaban ($4,093 vs $4,636, $1,476 vs $1,862, and $2,016 vs $2,121, respectively, all p <=.001) and warfarin ($4,199 vs $4,872, $1,505 vs $1,851, and $2,049 vs $2,514, respectively, all p<.001). Adjusted costs were similar for dabigatran and apixaban. Dabigatran patients had significantly fewer hospitalizations, outpatient visits, and pharmacy claims than rivaroxaban patients (0.06 vs 0.07, 4.84 vs 4.96 and 4.80 vs 4.93, respectively, all p<.020) and warfarin patients (0.06 vs 0.07, 4.77 vs 6.88, and 4.76 vs 5.89, respectively, all p<.001). Dabigatran patients had similar hospitalizations to apixaban, but higher outpatient visits (4.70 vs 4.31) and pharmacy claims (4.86 vs 4.61), both p<.001. Conclusions: This real-world study found adjusted all-cause costs were lower for dabigatran compared to rivaroxaban and warfarin patients and similar to apixaban patients.

BACKGROUND:Warfarin has a long history of use to reduce the risk of stroke in patients with atrial fibrillation (AF), but it requires frequent laboratory monitoring to maintain international normalized ratio levels in the therapeutic range. Dabigatran, a novel oral anticoagulant (OAC), has demonstrated efficacy in reducing the risk of stroke and systemic embolism and does not require laboratory monitoring.OBJECTIVE:To compare health care resource utilization (HCRU) and costs of OAC-naive patients newly diagnosed with nonvalvular atrial fibrillation (NVAF), using dabigatran or warfarin.METHODS:This retrospective observational study used data from medical and pharmacy claims extracted from the HealthCore Integrated Research Database representing commercial and Medicare Advantage members. Adults aged > 18 years with a medical diagnosis claim of NVAF were identified between October 1, 2010, and December 31, 2011. The date of first observed OAC prescription claim was the index date. Patients were followed for up to 12 months after the index date. Patients were assigned to the dabigatran or warfarin treatment groups based on their first OAC prescription fills. To reduce potential for selection bias, the cohorts were matched on baseline characteristics using propensity score matching. HCRU was measured and compared between groups on a per-patient-per-month (PPPM) basis for all-cause HCRU, as well as stroke, myocardial infarction, and bleed-specific HCRU. Pharmacy, medical, and total costs were also compared and adjusted to 2012 U.S. dollars. Generalized linear models were conducted to compare all-cause health care costs between cohorts.RESULTS:After propensity score matching, 1,648 patients were included in the analysis (824 each in the dabigatran and warfarin treatment groups). In the post-index period, patients in the dabigatran group had significantly fewer all-cause PPPM physician office visits (mean [SD] 1.29 [± 0.95] vs. 2.02 [± 1.53], P < 0.001) and outpatient visits (mean [SD] 2.17 [± 2.90] vs. 3.52 [± 3.32], P < 0.001) compared with those in the warfarin group. There were no between-group differences in outcomes for the number of stroke, myocardial infarction, or bleeding-related office visits. All-cause medical costs for the dabigatran cohort were lower than the warfarin cohort; however, the difference did not reach statistical significance ($2,696 [SD ± $6,699] vs. $2,893 [± $6,819], P = 0.179). All-cause pharmacy costs were higher in the dabigatran group versus the warfarin group ($455 [± $429] vs. $328 [± $517], P < 0.001). The dabigatran cohort also had significantly higher stroke-related ($32 [± $71] vs. $20 [± $55], P = 0.006) and nonstroke-related pharmacy costs ($423 [± $422] vs. $308 [± $515], P < 0.001). Despite higher pharmacy costs for the dabigatran cohort, both treatment groups had statistically similar all-cause total costs ($3,151 [± $6,744] vs. $3,221 [± $6,869], P = 0.701).CONCLUSIONS:This real-world study showed that among patients newly diagnosed with NVAF who were OAC naive, dabigatran use was associated with significantly less HCRU in terms of physician and outpatient visits but higher pharmaceutical costs in up to 12 months of follow-up. Similar to other real-world studies, this research supports the finding that higher pharmacy costs for dabigatran users was offset by lower medical costs, making total health care costs comparable between dabigatran and warfarin.DISCLOSURES:This work was supported by Boehringer Ingelheim Pharmaceuticals, which is the manufacturer of dabigatran, one of the products included in the analysis of this work. The authors were responsible for all content and editorial decisions. Jain and Tan are employed by HealthCore, a research consultancy which was funded by Boehringer Ingelheim Pharmaceuticals for work on this study. Fu was employed by HealthCore at the time of this study. Lim, Wang, Elder, and Sander are employees of Boehringer Ingelheim Pharmaceuticals. Study concept and design were contributed by Wang, Sander, and Tan, along with Fu and Jain. Fu, Tan, and Jain collected the data, and data interpretation was performed by Lim, Wang, and Sander, along with Jain, Tan, and Fu. The manuscript was written by Jain, Elder, Tan, and Wang, along with Lim and Fu, and revised by Jain, Wang, Elder, and Tan. Some of the results of this study were presented at Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke (QCOR) 2014 Scientific Sessions on June 2-4, 2014, in Baltimore, Maryland.

Objective: To assess the economic burden of cardiovascular events in Medicare beneficiaries with type 2 diabetes mellitus (T2DM).Methods: This claims-based actuarial analysis queried 2013 and 2014 Medicare 5% samples, defining a denominator of fee-for-service beneficiaries. Average per patient per month allowed cost ($PPPM) was calculated for T2DM, demographically adjusted non-T2DM, and denominator. Per member per month allowed cost ($PMPM) was calculated by dividing total population cost by member months in the denominator. Costs of five pre-specified cardiovascular events were calculated as a contribution to denominator $PMPM, as contribution to $ PPPM in T2DM, and as incremental cost.Results: During the study period, 22.1% of Medicare fee-for-service beneficiaries had T2DM; of these, 9.68% experienced a cardiovascular event or cardiovascular-related death. T2DM cost represented 37.9% of total allowed $PMPM for the denominator. Average total allowed $ PPPM for a T2DM beneficiary was $ 1,834, compared with $ 850 for a non-T2DM beneficiary (2.2-times higher). Annual rates of myocardial infarction, stroke, unstable angina admission, heart failure admission, and coronary revascularization in T2DM were 3.3-, 2.4-, 3.2-, 4.0-, and 2.8-times higher than in non-T2DM, and utilization of health services was also greater in T2DM. Cardiovascular events in T2DM accounted for 50% of denominator cardiovascular event cost; 3.6% of denominator population $PMPM was attributable to cardiovascular events in T2DM. Risk-adjusted incremental cardiovascular event cost represented 18.1% of $ PPPM in T2DM or 6.9% of $PMPM in the denominator population.Conclusions: Cardiovascular events in Medicare fee-for-service beneficiaries with T2DM contribute substantially to Medicare cardiovascular events, resource utilization, and cost.

Objective: To assess comparative resource use for patients given a new diagnosis of nonvalvular atrial fibrillation (NVAF) and newly treated with dabigatran or warfarin in a US real-world setting. Study Design: A retrospective cohort analysis was conducted using de-identified electronic health record data from a large, nationwide database of integrated delivery networks (IDNs). Methods: We identified newly diagnosed NVAF patients, newly treated with dabigatran or warfarin <= 90 days of diagnosis between October 1, 2010, and September 30, 2012. Patients had >= 1 year of data prior to initiating therapy (index date). Patients in the warfarin cohort were propensity score matched 1: 1 to patients in the dabigatran cohort and were followed up to 1 year after index to assess all-cause, stroke-related, and bleed-related healthcare resource use. Results: A total of 3890 patients (1945, dabigatran; 1945, warfarin) were included and balanced through the matching process. The probability of an all-cause hospitalization was significantly lower in the dabigatran cohort compared with the warfarin cohort (42.8% vs 47.5%; P =.007). The dabigatran cohort had significantly lower per-patient per-year (PPPY) hospital (1.07 vs 1.20), emergency department (ED) (0.36 vs 0.51), and physician office visits (10.64 vs 18.13), as well as mean length of hospital stay (4.0 vs 4.6 days), compared with the warfarin cohort (all P <. 001). Total PPPY stroke-related hospitalizations and physician office visits, and total PPPY bleed-related ED visits, were also significantly lower for the dabigatran cohort compared with the warfarin cohort (all P <. 05). Conclusions: Newly diagnosed NVAF patients, newly treated with dabigatran and receiving care in US IDNs, experienced fewer allcause healthcare resources than patients initiating warfarin.

Purpose: This study compared health care resource utilization (HCRU), costs, and persistence among patients newly diagnosed as having nonvalvular atrial fibrillation (NVAF) and newly treated with dabigatran versus warfarin.Methods: This retrospective claims-based study used data from a large US managed care organization. The earliest claim for dabigatran or warfarin during October 1, 2010 through October 31, 2011 was the index date, with cohort assignment based on index medication. Evidence of newly diagnosed NVAF within 30 days before the index date and no claims for oral anticoagulants during the 12-month preindex period were required. Cohorts were matched using propensity scores. Per-patient-per-month HCRU, costs, and persistence were calculated during the variable follow-up period of up to 12 months after the index date. Descriptive and multivariable analyses were used to examine differences in outcomes.Findings: After matching, 869 patients per cohort were identified (mean age, 67.8 years; 40.4% female). Compared with warfarin, dabigatran had fewer per patient-per-month emergency department (0.10 vs 0.13, P = 0.010), office (1.98 vs 2.96, P < 0.001), and outpatient (1.05 vs 1.48, P < 0.001) visits. Despite higher mean pharmacy costs for dabigatran (P < 0.001), mean total health care (P = 0.309) and medical costs (P = 0.568) were similar to warfarin. Persistence was higher with dabigatran versus warfarin (median, 204 vs 161 days; mean, 213.7 vs 195.5 days, P = 0.001).Implications: Among patients newly diagnosed as having NVAF, those newly treated with dabigatran had lower HCRU, higher persistence, and similar total health care costs compared with those treated with warfarin. (C) 2016 The Authors. Published by Elsevier HS Journals, Inc.

Background: Treatment guidelines recommend oral anticoagulation (OAC) for non-valvular atrial fibrillation (NVAF) patients at high stroke risk (CHADS2 score ≥2). Real-world practice may differ from guidelines. Objectives: To assess OAC treatment and persistence in newly diagnosed NVAF patients. Methods: Medical and pharmacy claims between 11/1/10-11/30/13 were used from the HealthCore Integrated Research Database to identify and describe NVAF patients without atrial fibrillation (AF) diagnosis within 12 months prior to initial claim (newly diagnosed). Treated patients had ≥1 pharmacy fill for an OAC (warfarin, dabigatran, rivaroxaban or apixaban) during the above period. Proportion of treated NVAF patients was calculated and stratified by CHADS2 score. Demographic and clinical characteristics were described. Persistence was measured from initiation of OAC to discontinuation or end of eligibility or study period (11/30/2014). Results: Among 45,092 newly diagnosed NVAF patients, 41.1% were treated with an O...

Purpose:Real-world healthcare resource utilization and costs were compared among patients with non-valvular atrial fibrillation (NVAF) receiving either dabigatran or warfarin.Methods:A retrospective cohort study was conducted using administrative claims data from the United States Department of Defense (DOD) Military Health System. Patients with newly diagnosed AF initiated on dabigatran or warfarin were identified using ICD-9 diagnosis, procedure and drug codes. Patients were observed for 3 months prior to treatment initiation to ascertain a diagnosis of valvular heart disease and 12 months for exclusion of those with a history of anticoagulation therapy. Propensity score matching was used to balance baseline characteristics between the two treatment cohorts. Medical and pharmacy utilization and costs were compared between the dabigatran and warfarin treatment groups for 3 and 12 months following treatment initiation.Results:A total of 1102 patients with newly diagnosed NVAF initiated on dabigatran were matched with corresponding warfarin-treated patients. In the 12 months following initiation of anticoagulation, the mean medical costs for patients initiated on dabigatran were significantly lower than for patients initiated on warfarin (-$6299, p<0.001), largely due to fewer hospitalizations (-0.162, p=0.009). While pharmacy costs were higher ($4369, p<0.001) for dabigatran, overall healthcare costs were significantly lower compared with patients on warfarin (12 months: -$1940, p<0.001). Mean hospital length of stay between these two groups were similar (6.033 days for dabigatran vs 6.318 days for warfarin, p=0.139).Conclusion:Despite higher pharmacy costs for NVAF patients initiated on dabigatran vs warfarin, this was more than offset by lower utilization of medical care resources.