B-PO05-145 CONTEMPORARY CLINICAL AND ECONOMIC OUTCOMES AMONG ORAL ANTICOAGULANT TREATED AND UNTREATED ELDERLY PATIENTS WITH ATRIAL FIBRILLATION

Abstract

Oral anticoagulants (OACs) are the standard of care for decreasing stroke risk in atrial fibrillation (AF) patients. This study compared clinical and economic outcomes between elderly AF patients treated with OACs (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin) and those who were not. Patients newly diagnosed with AF were identified from the Medicare database between January 2013 and December 2017. Patients were assigned to the OAC treated and untreated cohorts based on evidence of OAC treatment on or after the first AF diagnosis. Treated patients were assigned to drug cohorts based on the first OAC drug. Inverse probability treatment weighted time-dependent cox regression models were used to compare the risk of stroke/systemic embolism (SE), major bleeding (MB), and death between cohorts. Marginal structural models were used to compare costs. 1,421,187 AF patients comprised the two cohorts: OAC treated (N=583,350, 41.0%; 36.4% apixaban, 4.9% dabigatran, 0.1% edoxaban, 26.7% rivaroxaban, and 31.9% warfarin) and untreated (N=837,837, 59.0%). Compared with untreated patients, OAC treated patients had a lower risk of stroke/SE and death and a higher risk of MB. Consistent trends were observed for each drug cohort (Figure 1). Adjusted average total healthcare costs per patient per month of the OAC treated cohort were lower than untreated cohort ($4,381 vs $7,172; p<.0001). In a contemporary elderly population, the risk of stroke/SE and death were lower, while MB risk was higher among OAC treated patients, compared with untreated patients. Total costs were lower among OAC treated patients, compared with untreated patients.