Although warfarin is time-tested, the use of novel oral anticoagulants (NOACs) are a topic of interest to improve health outcomes in patients with non-valvular atrial fibrillation.

Warfarin requires regular international normalized ratio (INR) monitoring and is negatively affected by vitamin K in vegetables. Meanwhile, the NOAC dabigatran lacks cytochrome P450 interactions and does not require blood monitoring.

Compared with warfarin, dabigatran has greater mortality benefits and is associated with reduced risk of pulmonary embolism and intracranial bleeding.

A team of researchers addressed the impact of anticoagulant choice on length of stay and hospital costs in a new study published in a recent issue of Journal of Managed Care and Specialty Pharmacy.

The study investigators used a nationwide hospital operations database that included records from 400 American hospitals.

Study participants had pharmacy data for at least 12 months and provider data for at least 6 months to confirm that the patient was new to either study drug. Half as many patients were on dabigatran (646) than warfarin (1292).

The study investigators assessed length of stay, 30-day readmission rate, and readmission-associated health care costs. Inpatient costs were 12% lower among dabigatran patients when controlled for confounding variables.

The dabigatran group’s readmission rate within 30 days of discharge was comparable with that of the warfarin-treated patients. The cost of a readmission—around $9800—was comparable independent of the anticoagulant used, as well.

However, length of stay was 13% lower in the dabigatran group, while warfarin administration extended length of stay for 30% of patients.

Another finding was that 3 in 4 patients in the dabigatran group received expensive bridging. This represented an unnecessary cost, according to the researchers, since bridging is unnecessary with dabigatran because of its short 30- to 60-minute onset of action.

Even with this finding, the dabigatran cohort had lower costs by around $4240, which supported previous research that dabigatran could be a cost-effective alternative.
The researchers concluded that dabigatran-treated atrial fibrillation patients may have shorter hospitals stays with reduced expenses during the initial hospitalization.

However, the 30-day readmission rate and costs per readmission were comparable between warfarin and dabigatran patients.