P4569Rivaroxaban treatment strategies reduce costs associated with rehospitalizations due to bleeding and cardiovascular events: results from the PIONEER AF-PCI trial

Abstract

Background: The PIONEER AF-PCI trial demonstrated that among atrial fibrillation (AF) patients undergoing intracoronary stenting, either rivaroxaban 15 mg od plus P2Y12 inhibitor (Group 1) or 2.5 mg rivaroxaban bid plus DAPT (Group 2) was associated with a reduced risk of rehospitalization, primarily for bleeding and cardiovascular events, compared with VKA plus DAPT (Group 3). The costs associated with these strategies are unknown. Purpose: To estimate, from a U.S. perspective, the costs associated with rehospitalizations among rivaroxaban based anticoagulation strategies compared with VKA plus DAPT in the PIONEER AF-PCI trial. Methods: Medication costs were estimated using wholesale acquisition costs, medication discontinuation rates in PIONEER AF-PCI, and costs of monitoring obtained from the literature. Using a large U.S. healthcare insurance claims database, the mean adjusted increase in 1-year cost of care for individuals with AF and PCI who were rehospitalized for bleeding, cardiovascular, and other events were compared to those who were not. Using adjudicated rehospitalization rates from PIONEER, differences in costs of care were estimated for the three groups. Results: Rates of rehospitalization for bleeding were 6.5%, 5.4% and 10.5% and 20.3%, 20.3%, and 28.4% for cardiovascular events among Groups 1, 2, and 3 respectively. No differences in the rates of other hospitalizations were found among the groups. After multivariable adjustment, the mean increase in 1-year costs of care if a bleeding rehospitalization occurred was $79,723 and $48,861 for rehospitalizations involving cardiovascular events. Table 1 shows medication costs and cost per patient associated with clinical events for each group. Conclusion: Both rivaroxaban treatment strategies resulted in fewer rehospitalizations. The current cost analysis suggests that meaningful cost differences exist and that the magnitude of cost difference is greater for cardiovascular events compared with bleeding events. Future work is necessary to accurately estimate the costs associated with individual bleeding and cardiovascular events and to prospectively evaluate the costs of care associated with various anticoagulation strategies.