ACC: Apixaban more resource-friendly than warfarin

SAN FRANCISCO—Treating atrial fibrillation patients with apixaban may lighten the burden on the healthcare system, according to a poster presentation March 10 at the American College of Cardiology (ACC) scientific session. The analysis of ARISTOTLE data gave apixaban an edge over warfarin for resource use.

Patricia A. Cowper, PhD, of Duke Cardiology in Durham, N.C., and her colleagues examined data from ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) to assess resource use in the two patient groups under study. ARISTOTLE randomized 18,201 patients with atrial fibrillation and at least one additional risk factor to either be treated with the Xa factor inhibitor apixaban (Eliquis, Bristol-Myers Squibb and Pfizer) or warfarin.

“In the trial, there was a significant difference in mortality, stroke and bleeding” favoring apixaban, Cowper said. “With that evidence, there was some expectation that that would translate into savings of resources and subsequent costs.”

Using ARISTOTLE case report forms, Cowper and her colleagues obtained dates of hospitalizations, length of stay and dates of cardiac and non-cardiac procedures. They classified hospitalizations (cardiovascular or non-cardiovascular), procedure and the date of the adverse event and estimated hospitalization frequency.

They found that all-cause hospitalizations were lower in the apixaban group, at 25.9 percent vs. 27.2 percent in the warfarin group. They attributed much of the difference to cardiovascular hospitalizations (15.7 percent vs. 16.9 percent, respectively). The cumulative length of stay was shorter in the apixaban group (a mean of 2.86 days vs. 2.95 days) and the number of hospitalizations per patient in U.S. patients was lower in the apixaban group (a mean 0.41 vs. 0.48 at two years). They also noted a non-significant reduction in cumulative length of stay in the U.S. cohort.

Based on the analysis, for every 1,000 patients treated with apixaban instead of warfarin, 13 patients avoided hospitalization an average of 1.5 times.

“It looks like there is a savings in stroke,” Cowper added, based on an analysis of intensive care unit hospitalizations. The researchers expect to examine that data further. Their next step is to conduct a cost analysis to identify economic impacts and then a cost-effectiveness study.