Abstract 13140: Effectiveness of Rivaroxaban among Patients Diagnosed With Pulmonary Embolism

Abstract

Introduction: Rivaroxaban is a fixed-dose anticoagulant that facilitates earlier hospital discharge, potentially reducing patient exposure to hospital-acquired complications (HAC). Due to the recent introduction of rivaroxaban and limited evidence on its impact in real world settings, we compared the effectiveness of rivaroxaban vs. standard of care (SOC) among pulmonary embolism (PE) patients in the Veterans Health Administration. Methods: Adult patients with continuous enrollment for ≥12 months before and 3 months after an inpatient diagnosis of PE between 10/1/11 and 6/30/15, 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 (PSM) compared PE-related outcomes (recurrent venous thromboembolism (VTE), major bleeding and death), HAC, healthcare utilization, and costs among patients receiving SOC and rivaroxaban. We defined net clinical benefit as 1 minus the combined rate of PE-related outcomes and HAC. Results: Among 6,746 PE patients, 208 received rivaroxaban and 4,641 received SOC during the index hospitalization. Most (95%) were male; 22% were African American. After 1:3 PSM, there were 203 rivaroxaban and 609 SOC patients. Mean length of stay (LOS) was 6.3 days for rivaroxaban and 10.4 days for SOC (p=0.0402). In the 90-day post-discharge period, rivaroxaban users (vs. SOC) had similar rates of PE-related outcomes (recurrent VTE: 3.0% vs. 5.3%, p=0.1793, major bleeding: 2.0% vs. 2.6%, p=0.6011, death: 2.5% vs. 4.1%, p=0.2828), fewer HAC (10.3% vs. 15.9%, p=0.0506), and fewer bacterial pneumonias (10.3% vs. 17.2%, p=0.0188). Rivaroxaban users had better net clinical benefit (82.8% vs. 71.1%, p=0.0010). Rivaroxaban users had fewer outpatient visits per patient (17.0 vs. 19.9, p=0.0005), similar rehospitalization rates (0.18 vs. 0.26, p=0.0836), lower inpatient costs ($3,501 vs. $6,189, p<0.0001), and lower total costs ($10,545 vs. $14,192, p=0.0002). When the sample was limited to low-risk PE patients, we found similar patterns. Conclusions: PE patients prescribed rivaroxaban had similar PE-related outcomes but shorter LOS, fewer HACs, and lower total costs than patients on SOC.