Analysis of health care costs over a one-year period following anticoagulant therapy among Ontario patients diagnosed with atrial fibrillation
Abstract
Atrial fibrillation patients are at high risk of ischemic strokes, which can be drastically reduced using oral anticoagulants (OACs). Warfarin has been the standard OAC for this population but its effectiveness rests on consistent monitoring with the potential for severe bleeding events. Newer OACs, like rivaroxaban and apixaban, address these drawbacks but have a comparatively higher upfront cost. Uncertainty remains over which OAC is cost-saving from a health care system perspective. Using a retrospective cohort study design and inverse probability weighting regression adjustment estimators, one-year health care costs among patients treated with warfarin, rivaroxaban, and apixaban were compared. Compared to warfarin, rivaroxaban and apixaban treatments are cost-saving with per-patient one-year total health care savings at $2,436 and $1,764, respectively. This was driven by significant cost savings in hospitalization, emergency department visits, and physician visits for rivaroxaban and apixaban compared to warfarin. These results can influence provincial OAC reimbursement policies.