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https://hdl.handle.net/20.500.11779/685
Title: | Risk of Stroke/Systemic Embolism, Major Bleeding and Associated Costs in Non-Valvular Atrial Fibrillation Patients Who Initiated Apixaban, Dabigatran or Rivaroxaban Compared With Warfarin in the United States Medicare Population |
Authors: | Amin, Alpesh Lien Vo Trocio, Jeffrey Keshishian, A Liu, Xianchen Mardekian, Jack Zhang, Qisu Rosenblatt, Lisa Dina, Oluwaseyi Başer, Onur Le, Hannah |
Keywords: | Atrial fibrillation Stroke Direct oral anticoagulants Warfarin |
Source: | Amin, A., Keshishian, A., Zhang, Q., Trocio, J., Dina, O., Liu, X., Mardekian, J., ... Baser, O. (2017). Risk of stroke/systemic embolism, major bleeding and associated costs in non-valvular atrial fibrillation patients who initiated apixaban, dabigatran or rivaroxaban compared with warfarin in the United States Medicare population. Current Medical Research and Opinion, 33, 9, 1595-1604. |
Abstract: | Objective: To compare the risk and cost of stroke/systemic embolism (SE) and major bleeding between each direct oral anticoagulant (DOAC) and warfarin among non-valvular atrial fibrillation (NVAF) patients. Methods: Patients (65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Medicare database from 1 January 2013 to 31 December 2014. Patients initiating each DOAC were matched 1:1 to warfarin patients using propensity score matching to balance demographics and clinical characteristics. Cox proportional hazards models were used to estimate the risks of stroke/SE and major bleeding of each DOAC vs. warfarin. Two-part models were used to compare the stroke/SE- and major-bleeding-related medical costs between matched cohorts. Results: Of the 186,132 eligible patients, 20,803 apixaban-warfarin pairs, 52,476 rivaroxaban-warfarin pairs, and 16,731 dabigatran-warfarin pairs were matched. Apixaban (hazard ratio [HR]=0.40; 95% confidence interval [CI] 0.31, 0.53) and rivaroxaban (HR=0.72; 95% CI 0.63, 0.83) were significantly associated with lower risk of stroke/SE compared to warfarin. Apixaban (HR=0.51; 95% CI 0.44, 0.58) and dabigatran (HR=0.79; 95% CI 0.69, 0.91) were significantly associated with lower risk of major bleeding; rivaroxaban (HR=1.17; 95% CI 1.10, 1.26) was significantly associated with higher risk of major bleeding compared to warfarin. Compared to warfarin, apixaban ($63 vs. $131) and rivaroxaban ($93 vs. $139) had significantly lower stroke/SE-related medical costs; apixaban ($292 vs. $529) and dabigatran ($369 vs. $450) had significantly lower major bleeding-related medical costs. Conclusions: Among the DOACs in the study, only apixaban is associated with a significantly lower risk of stroke/SE and major bleeding and lower related medical costs compared to warfarin. |
Description: | Onur Başer (MEF Author) |
URI: | http://dx.doi.org/10.1080/03007995.2017.1345729 https://hdl.handle.net/20.500.11779/685 |
ISSN: | 0300-7995 1473-4877 |
Appears in Collections: | Ekonomi Bölümü Koleksiyonu PubMed İndeksli Yayınlar Koleksiyonu / PubMed Indexed Publications Collection Scopus İndeksli Yayınlar Koleksiyonu / Scopus Indexed Publications Collection WoS İndeksli Yayınlar Koleksiyonu / WoS Indexed Publications Collection |
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File | Description | Size | Format | |
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WOS000407959900007.pdf Until 2089-02-14 | Yayıncı Sürümü - Makale | 2.18 MB | Adobe PDF | View/Open |
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