{"id":15402,"date":"2023-05-17T00:00:00","date_gmt":"2023-05-17T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/publications\/journal-articles\/does-prescribing-apixaban-or-rivaroxaban-versus-warfarin-for-patients-diagnosed-with-atrial-fibrillation-save-health-system-costs-a-multivalued-treatment-effects-analysis\/"},"modified":"2023-07-24T15:35:06","modified_gmt":"2023-07-24T19:35:06","slug":"does-prescribing-apixaban-or-rivaroxaban-versus-warfarin-for-patients-diagnosed-with-atrial-fibrillation-save-health-system-costs","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/does-prescribing-apixaban-or-rivaroxaban-versus-warfarin-for-patients-diagnosed-with-atrial-fibrillation-save-health-system-costs\/","title":{"rendered":"Does prescribing apixaban or rivaroxaban versus warfarin for patients diagnosed with atrial fibrillation save health system costs? A multivalued treatment effects analysis"},"content":{"rendered":"<p><strong>Background<\/strong> \u2014 Non-valvular atrial fibrillation (AF) is a common heart arrhythmia in the elderly population. AF patients are at high-risk of ischemic strokes, but oral anticoagulant (OAC) therapy reduces such risks. Warfarin had been the standard OAC for AF patients, however its effectiveness is highly variable and dependent on close monitoring of the anticoagulant response. Newer OACs such as rivaroxaban and apixaban address these drawbacks but are more costly. It is uncertain which OAC therapy for AF is cost-saving from the healthcare system perspective.<\/p>\n<p><strong>Methods<\/strong> \u2014 We followed a cohort of patients in Ontario, Canada, aged \u2265 66 who were newly diagnosed with AF and prescribed OACs between 2012 and 2017. We used a two-stage estimation procedure. First, we account for the patient selection into OACs using a multinomial logit regression model and estimated propensity scores. Second, we used an inverse probability weighted regression adjustment approach to determine cost-saving OAC options. We also examined component-specific costs (i.e., drug, hospitalization, emergency department and physician) to understand the drivers of cost-saving OACs.<\/p>\n<p><strong>Results<\/strong> \u2014 We found that compared to warfarin, rivaroxaban and apixaban treatments were cost-saving options, with per-patient 1-year healthcare cost savings at $2436 and $1764, respectively. These savings were driven by cost-savings in hospitalization, emergency department visits, and physician visits, outweighing higher drug costs. These results were robust to alternative model specifications and estimation procedures.<\/p>\n<p><strong>Conclusions<\/strong> \u2014 Treating AF patients with rivaroxaban and apixaban than warfarin reduces healthcare costs. OAC reimbursement policies for AF patients should consider rivaroxaban or apixaban over warfarin as the first-line treatment.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u2014 Non-valvular atrial fibrillation (AF) is a common heart arrhythmia in the elderly population. AF patients are at high-risk of ischemic strokes, but oral anticoagulant (OAC) therapy reduces such risks. Warfarin had been the standard OAC for AF patients, however its effectiveness is highly variable and dependent on close monitoring of the anticoagulant response. [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[40,61,56],"migration-helper-qa-sample-set":[],"class_list":["post-15402","journal_article","type-journal_article","status-publish","hentry","topic-cardiovascular-disease","topic-health-economics","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"Situ M, Schwarz UI, Zou G, McArthur E, Kim RB, Garg AX, Sarma S.\u00a0<em>Eur J Health Econ<\/em>. 2023; May 17 [Epub ahead of print].","source_url":"https:\/\/doi.org\/10.1007\/s10198-023-01594-7","ices_scientist":[1371,1242],"site":[6739],"research_program":[6747],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"BD973AA0-0761-4A0E-86DD-8EFFA6B812C0","sitecore_item_name":"Does-prescribing-apixaban-or-rivaroxaban-versus-warfarin-for-patients","sitecore_field_values":"{\r\n  \"Title\": \"Does prescribing apixaban or rivaroxaban versus warfarin for patients diagnosed with atrial fibrillation save health system costs? A multivalued treatment effects analysis\",\r\n  \"Short title\": \"Does prescribing apixaban or rivaroxaban\",\r\n  \"Summary\": \"This study found that treating atrial fibrillation patients with rivaroxaban and apixaban than warfarin reduces healthcare costs.\",\r\n  \"Citation\": \"<p>Situ M, Schwarz UI, Zou G, McArthur E, Kim RB, Garg AX, Sarma S.&nbsp;<em>Eur J Health Econ<\/em>. 2023; May 17 [Epub ahead of print]. DOI: <a href=\"https:\/\/doi.org\/10.1007\/s10198-023-01594-7\" title=\"opens external link\">https:\/\/doi.org\/10.1007\/s10198-023-01594-7<\/a><\/p>\",\r\n  \"Abstract\": \"<p><strong>Background<\/strong> &mdash; Non-valvular atrial fibrillation (AF) is a common heart arrhythmia in the elderly population. AF patients are at high-risk of ischemic strokes, but oral anticoagulant (OAC) therapy reduces such risks. Warfarin had been the standard OAC for AF patients, however its effectiveness is highly variable and dependent on close monitoring of the anticoagulant response. Newer OACs such as rivaroxaban and apixaban address these drawbacks but are more costly. It is uncertain which OAC therapy for AF is cost-saving from the healthcare system perspective.<\/p>n<p><strong>Methods<\/strong> &mdash; We followed a cohort of patients in Ontario, Canada, aged &ge; 66 who were newly diagnosed with AF and prescribed OACs between 2012 and 2017. We used a two-stage estimation procedure. First, we account for the patient selection into OACs using a multinomial logit regression model and estimated propensity scores. Second, we used an inverse probability weighted regression adjustment approach to determine cost-saving OAC options. We also examined component-specific costs (i.e., drug, hospitalization, emergency department and physician) to understand the drivers of cost-saving OACs.<\/p>n<p><strong>Results<\/strong> &mdash; We found that compared to warfarin, rivaroxaban and apixaban treatments were cost-saving options, with per-patient 1-year healthcare cost savings at $2436 and $1764, respectively. These savings were driven by cost-savings in hospitalization, emergency department visits, and physician visits, outweighing higher drug costs. These results were robust to alternative model specifications and estimation procedures.<\/p>n<p><strong>Conclusions<\/strong> &mdash; Treating AF patients with rivaroxaban and apixaban than warfarin reduces healthcare costs. OAC reimbursement policies for AF patients should consider rivaroxaban or apixaban over warfarin as the first-line treatment.<\/p>\",\r\n  \"ICES Scientists\": \"{1B85818F-7E73-43A2-A470-9AE260D05CC4}|{95F0CC45-E886-4729-A10C-DC4813D54710}\",\r\n  \"Posted Date\": \"20230517T000000\",\r\n  \"Show on Publications Landing Page\": \"1\"\r\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2023\/May\/Does-prescribing-apixaban-or-rivaroxaban-versus-warfarin-for-patients"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Does prescribing apixaban or rivaroxaban versus warfarin for patients diagnosed with atrial fibrillation save health system costs? A multivalued treatment effects analysis<\/title>\n<meta name=\"description\" content=\"Background \u2014 Non-valvular atrial fibrillation (AF) is a common heart arrhythmia in the elderly population. 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