To address literature gaps on treatment with real-world evidence, this study compared effectiveness, safety, and cost outcomes among NVAF patients with coronary or peripheral artery disease (CAD, PAD) prescribed apixaban vs other oral anticoagulants. NVAF patients aged ≥65 years co-diagnosed with CAD/PAD initiating warfarin, apixaban, dabigatran, or rivaroxaban were selected from the US Medicare population (01JAN2013-30SEP2015). Propensity score matching was used to match apixaban vs warfarin, dabigatran, and rivaroxaban cohorts. Cox models were used to evaluate the risk of stroke/systemic embolism (SE), major bleeding (MB), all-cause mortality, and a composite of stroke/myocardial infarction/all-cause mortality. Generalized linear and two-part models were used to compare stroke/SE, MB, and all-cause costs between cohorts. 33,269 warfarin-apixaban, 9,335 dabigatran-apixaban, and 33,633 rivaroxaban-apixaban pairs were identified after matching. Compared with apixaban, stroke/SE risk was higher in warfarin (hazard ratio [HR]: 1.93; 95% confidence interval [CI]: 1.61-2.31), dabigatran (HR: 1.69; 95% CI: 1.18-2.43), and rivaroxaban (HR: 1.24; 95% CI: 1.01-1.51) patients. MB risk was higher in warfarin (HR: 1.67; 95% CI: 1.52-1.83), dabigatran (HR: 1.37; 95% CI: 1.13-1.68), and rivaroxaban (HR: 1.87; 95% CI: 1.71-2.05) patients vs apixaban. Stroke/SE- and MB- related medical costs per-patient per-month were higher in warfarin, dabigatran, and rivaroxaban patients vs. apixaban. Total all-cause health care costs were higher among warfarin and rivaroxaban patients compared with apixaban patients. In conclusion, compared with apixaban, patients on dabigatran, rivaroxaban, or warfarin had a higher risk of stroke/SE, MB, and event-related costs.
Renato D Lopes, Laine Thomas, Manuela Di Fusco, Allison Keshishian, Xuemei Luo, Xiaoyan Li, Cristina Masseria, Keith Friend, Jack Mardekian, Xianying Pan, Huseyin Yuce, W Schuyler Jones