Abstract 283: Healthcare Resource Utilization and Costs Associated with Oral Anticoagulant Reversal Therapy

Abstract

Introduction: Oral anticoagulants (OAC) are essential for stroke prevention in atrial fibrillation (AF). Occasionally, reversal of anticoagulation is critical for treating life-threatening or uncontrolled bleeding episodes, as well as emergency surgery/urgent procedures. Prothrombin complex concentrates (PCC) or specific anticoagulant reversal agents such as idarucizumab (IDA) are initiated in patients who present with a significant bleed or who require urgent surgery. Currently, there is a scarcity of published data regarding healthcare resource utilization (HCRU) or costs incurred by these anticoagulant reversal agents in patients with AF or venous thromboembolism (VTE). Hence, we sought to describe the HCRU and total costs sustained among patients with AF or VTE receiving IDA or PCC in US-based healthcare systems. Methods: A retrospective observational study using the Premier Healthcare Database was undertaken. The study included adult patients aged ≥18 years treated with IDA or 3 or 4-factor PCC (Kcentra, Feiba, Profilnine, or unspecified) to reverse the effects of dabigatran or warfarin, respectively, between October 2015 and February 2018. Patients who received PCC were excluded if they had no evidence of warfarin use, or were administered a direct OAC within the 12-month period prior to first hospitalization admission with a record of IDA/PCC use (index hospitalization). Clinical characteristics, HCRU, and total costs during index hospitalization for patients treated with IDA or PCC were examined by use of unadjusted descriptive analysis. Results: The median ages for IDA (n=1,232) and PCC (n=4,939) patients were 78 [IQR: 70-85] and 74 [IQR: 65-83] years, respectively. Both treatment groups had a slightly higher representation of males (55.0% for IDA, 55.2% for PCC), and were predominantly of Caucasian race (86.6% in IDA, 79.7% in PCC). Among IDA patients, 59.3% had life-threatening bleeds and 30.4% underwent emergency/urgent surgery, with 56.7% and 30.8% for PCC patients, respectively. The median length of stay for the index hospitalization was 6 [IQR: 3-9] and 7 [IQR: 4-14] days for patients who received IDA or PCC, respectively. Intensive Care Unit admission rates were 61.3% for IDA patients and 68.7% for PCC patients. Median total costs per hospitalization were $19,357 for IDA patients and $26,920 for PCC patients, with the median cost of IDA and PCC therapy per hospitalization being $3,277 and $4,424, respectively. Conclusions: This observational, descriptive analysis revealed numerically lower HCRU and total hospital costs in patients administered IDA compared with PCC for reversal of OAC, though there were differences in population characteristics. Further studies are needed to determine the factors that potentially drive the disparate HCRU and associated costs between patients receiving IDA or PCC.