Estimation of the impact of warfarin's time-in-therapeutic range on stroke and major bleeding rates and its influence on the medical cost avoidance associated with novel oral anticoagulant use-learnings from ARISTOTLE, ROCKET-AF, and RE-LY trials

Amin, Alpesh, Deitelzweig, Steve, Jing, Yonghua, Makenbaeva, Dinara, Wiederkehr, Daniel, Lin, Jay and Graham, John (2014) Estimation of the impact of warfarin's time-in-therapeutic range on stroke and major bleeding rates and its influence on the medical cost avoidance associated with novel oral anticoagulant use-learnings from ARISTOTLE, ROCKET-AF, and RE-LY trials. Journal of Thrombosis and Thrombolysis, 38 2: 150-159. doi:10.1007/s11239-013-1048-z


Author Amin, Alpesh
Deitelzweig, Steve
Jing, Yonghua
Makenbaeva, Dinara
Wiederkehr, Daniel
Lin, Jay
Graham, John
Title Estimation of the impact of warfarin's time-in-therapeutic range on stroke and major bleeding rates and its influence on the medical cost avoidance associated with novel oral anticoagulant use-learnings from ARISTOTLE, ROCKET-AF, and RE-LY trials
Journal name Journal of Thrombosis and Thrombolysis   Check publisher's open access policy
ISSN 1573-742X
0929-5305
Publication date 2014-08
Year available 2014
Sub-type Article (original research)
DOI 10.1007/s11239-013-1048-z
Open Access Status Not yet assessed
Volume 38
Issue 2
Start page 150
End page 159
Total pages 10
Place of publication New York, NY, United States
Publisher Springer New York LLC
Language eng
Formatted abstract
Warfarin's time-in-therapeutic range (TTR) is highly variable among patients with nonvalvular atrial fibrillation (NVAF). The objective of this study was to estimate the impact of variations in wafarin's TTR on rates of stroke/systemic embolism (SSE) and major bleedings among NVAF patients in the ARISTOTLE, ROCKET-AF, and RE-LY trials. Additionally, differences in medical costs for clinical endpoints when novel oral anticoagulants (NOACs) were used instead of warfarin at different TTR values were estimated. Quartile ranges of TTR values and corresponding event rates (%/patient - year = %/py) of SSE and major bleedings among NVAF patients treated with warfarin were estimated from published literature and FDA documents. The associations of SSE and major bleeding rates with TTR values were evaluated by regression analysis and then the calculated regression coefficients were used in analysis of medical cost differences associated with use of each NOAC versus warfarin (2010 costs; US payer perspective) at different TTRs. Each 10 % increase in warfarin's TTR correlated with a -0.32 %/py decrease in SSE rate (R2 = 0.61; p < 0.001). Although, the rate of major bleedings decreased as TTR increased, it was not significant (-0.035 %/py, p = 0.63). As warfarin's TTR increased from 30 to 90 % the estimated medical cost decreased from -$902 to -$83 for apixaban, from -$506 to +$314 for rivaroxaban, and from -$596 to +$223 for dabigatran. Among NVAF patients there is a significant negative correlation between warfarin's TTR and SSE rate, but not major bleedings. The variations in warfarin's TTR impacted the economic comparison of use of individual NOACs versus warfarin.
Keyword Atrial fibrillation
Oral anticoagulants
Stroke
Warfarin
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 16 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Fri, 05 Aug 2016, 19:45:49 EST by System User on behalf of Learning and Research Services (UQ Library)