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Hospital length-of-stay and costs among pulmonary embolism patients treated with rivaroxaban versus parenteral bridging to warfarin

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Abstract

We sought to compare length-of-stay (LOS), total hospital costs, and readmissions among pulmonary embolism (PE) patients treated with rivaroxaban versus parenterally bridged warfarin. We identified adult PE (primary diagnostic code = 415.1x) patients in the Premier Database (11/2012-9/2015), and included those with ≥1 PE diagnostic test on days 0–2. Rivaroxaban users (allowing ≤2 days of prior parenteral therapy) were 1:1 propensity score matched to patients parenterally bridged to warfarin. LOS, total costs, and readmission for venous thromboembolism (VTE) or major bleeding within the same or subsequent 2 months were compared between cohorts. Separate analyses were performed in low-risk PE patients. Rivaroxaban use was associated with a 1.4-day [95 % confidence interval (CI) −1.47 to −1.28] shorter LOS, and $2322 (95 % CI −$2499 to −$2146) reduction in costs compared to parenterally bridged warfarin (p < 0.001 for both). There was no difference in readmission for VTE (1.5 versus 1.7 %) or major bleeding (0.3 versus 0.2 %) between the rivaroxaban and parenterally bridged warfarin cohorts (p ≥ 0.27 for both). Results were similar in low-risk patients (0.2–1.0 day and $251–$1751 reductions in LOS and costs, respectively, p ≤ 0.01 for all). In patients with PE, rivaroxaban was associated with reduced LOS and costs, without increased risk of readmission versus parenterally bridged warfarin. Similar results were observed in low-risk PE patients.

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Authors and Affiliations

  1. School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Storrs, CT, 06269, USA

    Erin R. Weeda & Craig I. Coleman

  2. Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada

    Philip S. Wells

  3. Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA

    W. Frank Peacock

  4. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA

    Gregory J. Fermann

  5. Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Christopher W. Baugh

  6. Janssen Scientific Affairs, LLC, Raritan, NJ, USA

    Veronica Ashton, Concetta Crivera, Peter Wildgoose & Jeff R. Schein

Authors
  1. Erin R. Weeda
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  2. Philip S. Wells
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  3. W. Frank Peacock
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  4. Gregory J. Fermann
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  5. Christopher W. Baugh
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  6. Veronica Ashton
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  7. Concetta Crivera
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  8. Peter Wildgoose
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  9. Jeff R. Schein
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  10. Craig I. Coleman
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Corresponding author

Correspondence to Craig I. Coleman.

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Funding

This analysis was sponsored by Janssen Scientific Affairs, LLC, Raritan, NJ, USA.

Conflict of interest

Dr. Coleman has received Grant funding and consultancy fees from Janssen Pharmaceuticals; Bayer Pharma AG and Boehringer-Ingelheim Pharmaceuticals, Inc. Mrs. Ashton and Drs. Crivera, Schein, and Wildgoose are employees of Janssen Scientific Affairs LLC. Dr. Peacock has received Grant funding and consultancy fees from Janssen Pharmaceuticals and Portola. Dr. Fermann has received Grant funding from Pfizer and is on the advisory board and speaker’s bureau for Janssen Pharmaceuticals. Dr. Baugh is a Roche Diagnostics Advisory Board member and received consulting fees from Janssen Pharmaceuticals. He also reports research support from Janssen Pharmaceuticals and Boehringer Ingelheim. Dr. Wells has received Grant funding from Bristol Myers Squib and Pfizer, is on the advisory board and has received speaker’s fees from Bayer Healthcare, has received consultancy fees from Janssen Pharmaceuticals, and served on a writing committee with Itreas. Dr. Weeda has no conflict of interest germane to this manuscript to report. No non-financial conflicts of interest exist for any of the authors.

Statements on human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required. It should also be noted that all data were de-identified; thus, our study was exempted from institutional review board oversight.

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Weeda, E.R., Wells, P.S., Peacock, W.F. et al. Hospital length-of-stay and costs among pulmonary embolism patients treated with rivaroxaban versus parenteral bridging to warfarin. Intern Emerg Med 12, 311–318 (2017). https://doi.org/10.1007/s11739-016-1552-1

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