Head-to-Head Study Compares Healthcare Costs of Anticoagulants

Dabigatran etexilate mesylate (Pradaxa) may result in lower costs compared with other novel oral anticoagulants.

Boehringer Ingelheim Pharmaceuticals recently announced results from a real-world study that compared healthcare costs and healthcare resource utilization (HCRU) among novel oral anticoagulants (NOACs). These findings could be leveraged to make clinical and formulary decisions in the future, according to the manufacturer.

The investigators reported that treatment with dabigatran etexilate mesylate (Pradaxa) led to lower all-cause healthcare costs and HCRU compared with rivaroxaban, according to a press release. They found that dabigatran etexilate mesylate resulted in higher all-cause outpatient and pharmacy HCRU, but similar all-cause costs and hospitalizations, compared with apixaban.

The findings were presented at the International Society for Pharmacoeconomics and Outcomes Research 22nd Annual International Meeting.

Dabigatran etexilate mesylate is indicated to lower the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). Currently, the product labeling for dabigatran etexilate mesylate does not include head-to-head comparisons with other NOACs, as a clinical trial was not conducted to do so, according to the release.

“While many studies have examined real-world outcomes with NOACs relative to warfarin, this is one of the first studies to compare NOACs against each other in terms of their impact on costs and HCRU,” said Stacey Long, senior vice president and general manager, Truven Health Life Sciences, IBM Watson Health. “This study provides valuable insights that can help physicians better understand the costs to patients and our healthcare system associated with NOAC treatment decisions.”

Included in the study were data from 70,898 patients with NVAF who were newly treated with dabigatran etexilate mesylate, rivaroxaban, or apixaban. Data were gathered between April 2010 and December 2015 for Medicare beneficiaries and patients with commercial insurance.

The primary outcome was all-cause healthcare costs per-patient per-month (PPPM) and the secondary outcome was all-cause HCRU PPPM.

Compared with rivaroxaban, dabigatran etexilate mesylate was linked to approximately $500 lower PPPM month costs and nearly $400 less PPPM in inpatient costs.

Additional analyses discovered that dabigatran etexilate mesylate was associated with lower total costs ($4093 versus. $4636), inpatient costs ($1476 versus $1862), outpatient costs ($2016 versus $2121), and pharmacy costs ($634 versus $645), according to the study.

Dabigatran etexilate mesylate was observed to have similar PPPM total costs, inpatient costs, outpatient costs, and pharmacy costs compared with rivoroxaban.

However, when compared with apixaban, dabigatran etexilate mesylate was linked to higher outpatient visits and outpatient pharmacy claims. The drugs were reported to have similar inpatient admissions.

The drug also was linked to a significantly lower all-cause HCRU — including less inpatient admissions, outpatient visits, and outpatient pharmacy claims – compared with rivaroxaban, according to the study.

These findings show the real-world value of dabigatran etexilate mesylate and other NOACs, which provides important for patients and providers.

“Hospitalizations and office visits related to NVAF cost the US healthcare system over $6 billion each year,” said Sabine Luik, MD, senior vice president, Medicine & Regulatory Affairs, Boehringer Ingelheim Pharmaceuticals, Inc. “At Boehringer Ingelheim, we are committed to studying our therapies in real-world settings, and believe this analysis provides important new information on the economic impact of treatment with PRADAXA, which has the longest real-world experience of any available NOAC."