Comparative analysis of all-cause health care resource utilization and costs among patients with non-valvular atrial fibrillation and high risk of gastrointestinal bleeding in France: a nationwide cohort analysis

Abstract

Aims: This population-based cohort study compared healthcare resource utilization (HCRU) and direct HCRU costs (medical and non-medical) in French patients with non-valvular atrial fibrillation (NVAF) and at high-risk of gastrointestinal bleeding (GIB) after initiating an anticoagulant treatment with vitamin-K antagonists (VKAs) or with direct-oral anticoagulants (DOACs).

Methods: NVAF patients at high risk of GIB who initiated apixaban, rivaroxaban, dabigatran, or VKAs between 2016 and 2019 were identified from the French National Healthcare Data System (SNDS) database. The first anticoagulant reimbursement set the index date and patients were followed-up until drug discontinuation/switch, death, or study end, whichever came first. Differences in patient characteristics were balanced using 1:1 propensity score matched (PSM) cohorts. Direct (medical and non-medical) HCRU and costs per patient per month (PPPM) were compared using two-part generalized linear models.

Results: A total of 314,184 patients were identified (mean age 79.0 years; 51.0% female). In PSM cohorts, patients treated with DOACs had less outpatient visits, laboratory tests, and hospitalizations as compared to patients treated with VKAs. Each DOAC was associated with lower direct HCRU costs PPPM than VKAs (apixaban/VKAs: €1,868/€2,082; rivaroxaban/VKA: €1,788/€1,982; dabigatran/VKA: €1,461/€1,665; all p < .001). In DOAC-DOAC comparisons, apixaban was associated with lower direct HCRU costs than rivaroxaban and dabigatran (apixaban/rivaroxaban: €1,424/€1,460; apixaban/dabigatran: €1,444/€1,460), while rivaroxaban was associated with lower direct HCRU costs than dabigatran (rivaroxaban/dabigatran: €1,447/€1,459; all p < .001).

Conclusions: In patients at high-risk of GIB, DOACs were associated with reduced direct HCRU costs compared to VKAs. Among DOACs, apixaban was associated with reduced direct HCRU costs.

Keywords: Atrial fibrillation; D61; I11; I18; costs; direct oral anticoagulants; gastrointestinal bleeding; healthcare resource utilization; vitamin-K antagonists.