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

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≤2days 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 2months 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 (1.5versus 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 (0.2-1.0day 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.