Scientific Publications Database

Article Title: Overall Effectiveness of Rivaroxaban in Patients with Pulmonary Embolism
Authors: Wang, Li; Baser, Onur; Wells, Phil; Peacock, W. Frank; Coleman, Craig I.; Fermann, Gregory J.; Schein, Jeff; Crivera, Concetta
Journal: CLINICAL THERAPEUTICS Volume 39 Issue 7
Date of Publication:2017
Abstract:
Purpose: Due to limited evidence on the impact of rivaroxaban in clinical practice, we compared the effectiveness of rivaroxaban versus standard of care (SOC) among patients in the Veterans Health Administration.Methods: Adult patients with continuous enrollment in a health plan with medical and pharmacy benefits for >= 12 months before and >= 3 months after an inpatient diagnosis of pulmonary embolism (PE) between October 1, 2011, and June 30, 2015, and a prescription claim for an anticoagulant during the index hospitalization, were included. SOC drugs were low-molecular weight heparin, unfractionated heparin, and warfarin. Propensity score matching was used in comparing PE related outcomes (recurrent venous thromboembolism, major bleeding, and death), hospital-acquired complications (HACs), health care resource utilization, and costs among patients receiving SOC versus rivaroxaban. We defined net clinical benefit as 1 minus the combined rate of PE-related outcomes and HACs.Findings: Among 6746 patients with PE, 208 received rivaroxaban, 4641 received SOC and 1897 received other anticoagulants. Most (95%) were male; 22% were black. After 1:3 propensity score matching, there were 203 rivaroxaban and 609 SOC patients. During the 90-day follow-up, rivaroxaban users had similar rates of PE-related outcomes, but fewer had experienced at least 1 HAC (10.3% vs 15.9%; P = 0.0506), resulting in better net clinical benefit (82.8% vs 71.1%; P = 0.001). Rivaroxaban users had fewer outpatient visits per patient (17.0 vs 19.9; P = 0.0005), a similar rehospitalization rate (0.2 vs 0.3; P = 0.084), lesser inpatient costs (US $3501 vs $6189; P < 0.0001), lesser inpatient costs and lesser total costs ($10,545 vs $14,192; P = 0.0002). When the sample was limited to patients with low-risk PE, we found similar patterns. (C) 2017 Elsevier HS Journals, Inc. All rights reserved.