Healthcare Resource Utilization among Non-Valvular Atrial Fibrillation Patients Who Switched from Warfarin to a Novel Oral Anti-Coagulant

Abstract

Among patients with non-valvular atrial fibrillation (NVAF), switching from warfarin to novel oral anticoagulants (NOACs) is common, yet clarifying the differences in the effect of NOACs on all-cause healthcare resource utilization (HCRU) are unknown. Adult NVAF patients who switched from warfarin to dabigatran, apixaban, or rivaroxaban were identified in MarketScan databases between 10/2010-12/2015. Patients had 12 months pre-period (index date was 1st NOAC claim) and were followed up to 12 months until medication discontinuation, end of enrollment, inpatient death, or 12/2016. Overall, 8,679 and 5,761 dabigatran switchers were matched (1:1) to rivaroxaban and apixaban switchers (mean age 73-74 years). Compared with rivaroxaban switchers, a lower proportion of dabigatran switchers had an inpatient (IP) visit (20.0% vs. 21.6%, p=0.008). Dabigatran switchers had lower per-patient-per-month (PPPM) total outpatient (3.87 vs. 4.06, p=0.002), emergency department (ED; 0.48 vs. 0.52, p=0.026), outpatient office (1.17 vs. 1.22, p<0.001), and other outpatient (2.71 vs. 2.83, p=0.043) visits compared with rivaroxaban switchers. A similar proportion of dabigatran and apixaban switchers had an IP visit (20.7% vs. 21.2%); compared with apixaban switchers, dabigatran switchers had significantly more PPPM IP visits (0.23 vs. 0.21, p=0.031) but significantly lower ED visits (0.47 vs. 0.52, p=0.016). Post-discharge 30-day readmission rates were comparable among warfarin-to-NOAC switching groups. Time to readmission was longer for dabigatran versus rivaroxaban switchers (8.2 vs. 7.8 days, p<0.001), but comparable with apixaban patients (8.1 vs. 8.4 days). Switching to dabigatran after warfarin discontinuation may lower HCRU among NVAF patients compared with switching to rivaroxaban or apixaban.