Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Original Article

Volume 13, Number 1, February 2022, pages 27-43

Healthcare Resource Utilization for Oral Anticoagulant Reversal Therapies in Non-Valvular Atrial Fibrillation/Venous Thromboembolism Patients

Figure

Figure 1.
Figure 1. Patient attrition schematic and overall study population as well as the study population stratified by indication for oral anticoagulation reversal and type of bleed.

Tables

Table 1. Patient, Visit, and Hospital Characteristics
 
IDAPCCP-value (IDA vs. PCC)
N%N%
*Patients included in the emergency/urgent group were those who were identified as having “emergency” or “urgent” type of admission or admitted from a Trauma Center. IDA: idarucizumab; PCC: prothrombin complex concentrates.
No. of patients/discharges1,2324,939
Patient characteristics
  Age
    Median78-74-< 0.001
    25th Percentile70-65-
    75th Percentile85-83-
  Age group (n, %)
    18 - 44201.61853.7< 0.001
    45 - 54373.02905.9
    55 - 641008.174915.2
    65 - 7430024.41,30626.4
    75 - 8446137.41,46529.7
    85+31425.594419.1
  Sex (n, %)
    Female55445.02,21144.80.876
    Male67855.02,72755.2
    Unknown--10.0
  Race (n, %)
    White1,06786.63,93879.7< 0.001
    Black483.954211.0
    Other1008.13607.3
    Unknown171.4992.0
  Ethnicity (n, %)
    Hispanic or Latino403.21994.00.076
    Not Hispanic or Latino97879.43,77476.4
    Unknown21417.496619.6
  Health care coverage type (n, %)
    Commercial1098.855211.2< 0.001
    Medicaid312.53457.0
    Medicare1,04885.13,91279.2
    Other443.61302.6
Visit characteristics
  Admission type* (n, %)
    Elective514.12825.7< 0.001
    Emergency/urgent1,17595.44,64594.0
    Unknown60.5120.2
Hospital characteristics
  No. of hospitals333369
  Urbanicity
    Rural14611.93036.1< 0.001
    Urban1,08688.14,63693.9
  Teaching status
    Non-teaching66554.02,05941.7< 0.001
    Teaching56746.02,88058.3
  US Census Division (n, %)
    East North Central13611.097719.8< 0.001
    East South Central725.81533.1
    Middle Atlantic23819.380516.3
    Mountain141.1982.0
    New England413.32765.6
    Pacific17514.273114.8
    South Atlantic36229.41,33427.0
    West North Central967.83396.9
    West South Central988.02264.6
  Bed size
    ≤ 99473.8998.4< 0.001
    100 - 19912410.13246.6
    200 - 29921117.154511.0
    300 - 49937230.21,39628.3
    500+47838.82,57552.1

 

Table 2. Clinical Characteristics
 
IDAPCCP-value (IDA vs. PCC)
N%N%
aA patient may have both NVAF and VTE diagnoses during the index hospitalization. IDA: idarucizumab; PCC: prothrombin complex concentrates; OAC: oral anticoagulant; NVAF: non-valvular atrial fibrillation; VTE: venous thromboembolism; DVT: deep vein thrombosis; PE: pulmonary embolism; CCI: Charlson Comorbidity Index; HAS-BLED: Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol; CHA2DS2-VASc: Congestive heart failure, Hypertension, Age ≥ 75 Years, Diabetes mellitus, prior Stroke or transient ischemic attack, Vascular disease, Age 65 - 74 years, Sex category; CAD: coronary artery disease; PAD: peripheral artery disease; MI: myocardial infarction; CHF: congestive heart failure; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; TIA: ischemic stroke/transient ischemic attack; CABG: coronary artery bypass grafting; PCI: percutaneous coronary intervention; tPA: tissue plasminogen activator.
No. of patients/discharges1,2324,939
Clinical characteristics and comorbidities
  Indication of reversal therapy (N, %)
    Life-threatening bleed73159.32,80156.70.096
    Emergency/urgent surgery/procedure37530.41,52130.80.808
    Both1058.558911.9< 0.001
    Unspecified23118.81,20624.4< 0.001
  OAC indication (N, %)
    NVAFa1,10089.33,58572.6< 0.001
    VTEa514.14298.7< 0.001
    DVT393.23617.3< 0.001
    PE161.31132.30.030
    Other1119.01,13322.9< 0.001
  Deyo-modified CCI
    Median2-4-<0.001
    25th percentile1-2-
    75th percentile4-5
  HAS-BLED score
    Median3-3-< 0.001
    25th percentile2-2-
    75th percentile4-4-
  CHA2DS2-VASc score
    Median4-4-0.014
    25th percentile3-3-
    75th percentile5-5-
  Individual comorbidities (n, %)
    Gastrointestinal bleed45637.01,42228.8< 0.001
    Intracranial hemorrhage24820.11,25325.40.001
    CAD54244.02,40948.80.003
    PAD13811.268313.80.015
    MI17514.290718.40.001
    CHF48939.72,56151.9< 0.001
    CKD35528.82,32347.0< 0.001
    Acute kidney failure46537.71,88338.10.805
    Cirrhosis/hepatitis312.51623.30.168
    Hypertension47538.62,63353.3< 0.001
    Dyslipidemia69156.12,67254.10.210
    Diabetes mellitus42134.22,06841.9< 0.001
    COPD32826.61,53531.10.002
    Cancer/history of cancer31925.91,39428.20.102
    TIA403.21753.50.612
    CABG70.6831.70.004
    Other open-heart surgery413.34088.3< 0.001
    PCI00.040.10.318
    Other closed cardiac procedures24019.51,30726.5< 0.001
    History of falls473.81984.00.755
    Dementia18014.654411.0< 0.001
    Depression/anxiety24620.01,12422.80.035
Treatment characteristics
  tPA administration (n, %)373.03236.5< 0.001
  Days from admission to principal procedure code
    Median1-2-< 0.001
    25th percentile1-1-
    75th percentile3-3-
  Restart of OAC following the use of reversal during index hospitalization (n, %)
    Dabigatran20016.280.2< 0.001
    Warfarin362.91,59632.3< 0.001

 

Table 3. Resource Utilization and Cost Outcomes
 
IDAPCCP-value (IDA vs. PCC)
IDA: idarucizumab; PCC: prothrombin complex concentrates; FFP: fresh frozen plasma; PRBC: packed red blood cells.
No. of patients/discharges1,2324,939
Other reversal agents
  NovoSeven (rFVIIa)
    Cost
      N with non-zero value849
      %0.61.00.261
      Median$11,135$7,1560.638
      25th percentile$3,605$3,779
      75th percentile$17,927$14,848
Blood products
  FFP
    Cost
      N with non-zero value2191720
      %17.834.8< 0.001
      Median$164$2030.011
      25th percentile$68$97
      75th percentile$363$421
  Cryoprecipitate
    Cost
      N with non-zero value28285
      %2.35.8< 0.001
      Median$296$5120.002
      25th percentile$70$207
      75th percentile$536$1,010
  Platelets
    Cost
      N with non-zero value14152
      %1.13.1< 0.001
      Median$118$4220.004
      25th percentile$55$205
      75th percentile$388$876
  PRBC
    Cost
      N with non-zero value68150
      %5.53.0< 0.001
      Median$500$5300.286
      25th percentile$238$343
      75th percentile$867$955
Other agents costs
  Volume expanders
    Cost
      N with non-zero value1,0534,410
      %85.589.3< 0.001
      Median$90$121< 0.001
      25th percentile$26$33
      75th percentile$225$365
  Fibrinogen
    Cost
      N with non-zero value2051043
      %16.621.1< 0.001
      Median$20$230.032
      25th percentile$14$14
      75th percentile$38$58
  Tranexamic acid
    Cost
      N with non-zero value26121
      %2.12.40.484
      Median$65$930.062
      25th percentile$42$51
      75th percentile$113$129
  Albumin
    Cost
      N with non-zero value2921,609
      %23.732.6< 0.001
      Median$117$241< 0.001
      25th percentile$15$49
      75th percentile$352$753
  Vitamin K
    Cost
      N with non-zero value1243939
      %10.179.8< 0.001
      Median$39$440.472
      25th percentile$17$23
      75th percentile$79$70
Other costs and outcomes
  Pharmacy costs
    Cost
      N with non-zero value12144909
      %98.599.40.002
      Median$4,793$7,039< 0.001
      25th percentile$3,094$4,281
      75th percentile$7,399$12,067
  Laboratory costs
    Cost
      N with non-zero value12194913
      %98.999.50.036
      Median$605$937< 0.001
      25th percentile$346$470
      75th percentile$1,130$1,945
  Hemodialysis
    Days
      N with non-zero value44766
      %3.615.5< 0.001
      Median240.003
      25th percentile12
      75th percentile4.58
    Costs
      N with non-zero value44760
      %3.615.4< 0.001
      Median$1,780$2,2850.060
      25th percentile$612$942
      75th percentile$3,296$5,247

 

Table 4. Length of Stay and Cost Outcomes
 
IDAPCCP-value (IDA vs. PCC)
IDA: idarucizumab; PCC: prothrombin complex concentrates; LOS: length of stay; ICU: intensive care unit.
No. of patients1,2324,939
Hospitalization outcomes
  Total hospital LOS (days)
      Median67< 0.001
      25th percentile34
      75th percentile914
  ICU admission
      N7553,392
      %61.368.7< 0.001
  ICU LOS (days)
      Median12< 0.001
      25th percentile00
      75th percentile35
Hospital cost outcomes
  Total hospitalization
    Cost
      Median$19,357$26,920< 0.001
      25th percentile$12,461$16,125
      75th percentile$33,490$50,901
  IDA
    Cost
      Median$3,277
      25th percentile$1,885
      75th percentile$4,984
  PCC
    Cost
      Median$4,424
      25th percentile$2,540
      75th percentile$7,404

 

Table 5. Sub-Analysis of Length of Stay and Costs Stratified by Indication for Oral Anticoagulant Reversal (A) and Type of Bleed (B)
 
A. Indication for oral anticoagulant reversal
Life-threatening bleed onlyEmergency surgery or urgent procedure onlyBothUnspecified
IDAPCCP-value (IDA vs. PCC)IDAPCCP-value (IDA vs. PCC)IDAPCCP-value (IDA vs. PCC)IDAPCCP-value (IDA vs. PCC)
No. of discharges/patients6262,2122709321055892311,206
Total LOS (days)
  Median550.006610< 0.0019100.02358< 0.001
  25th percentile33366634
  75th percentile9910181319917
LOS from treatment index date to discharge (days)
  Median550.06358< 0.001890.18156< 0.001
  25th percentile33345523
  75th percentile889141216812
ICU admission
  N3931,46415564773496134785
  %62.8%66.2%0.11457.4%69.4%< 0.00169.5%84.2%< 0.00158.0%65.1%0.04
ICU LOS (days)
  Median110.02712< 0.001240.00212< 0.001
  25th percentile00000100
  75th percentile33365836
Total hospital cost ($)
  Median$16,224$19,988< 0.001$25,376$43,724< 0.001$32,209$40,0820.055$19,251$29,932< 0.001
  25th percentile$10,621$13,218$16,887$25,555$19,734$25,912$10,974$15,910
  75th percentile$26,042$32,094$43,562$72,781$54,300$65,328$34,386$70,234
Oral reversal agent cost ($)
  IDA
    Median$3,279$3,263$3,474$3,258
    25th percentile$1,959$1,735$1,916$1,787
    75th percentile$4,906$4,453$5,380$5,365
  PCC
    Median$4,584$4,496$4,014$4,371
    25th percentile$2,603$2,565$2,290$2,529
    75th percentile$7,332$7,528$6,767$7,561
B. Type of bleed
Gastrointestinal bleed onlyIntracranial hemorrhageBothNo evidence of GI bleed or ICH
IDAPCCP-value (IDA vs. PCC)IDAPCCP-value (IDA vs. PCC)IDAPCCP-value (IDA vs. PCC)IDAPCCP-value (IDA vs. PCC)
IDA: idarucizumab; PCC: prothrombin complex concentrates; LOS: length of stay; ICU: intensive care unit.
No. of discharges/patients4511,3802431,2115425332,306
Total LOS (days)
  Median56< 0.00146< 0.001490.80169< 0.001
  25th percentile34234635
  75th percentile91181123231016
LOS from treatment index date to discharge (days)
  Median56< 0.001550.021480.44557< 0.001
  25th percentile33234533
  75th percentile8108102320912
ICU admission
  N2839031759494342931,506
  %62.7%65.4%0.372.0%78.4%0.03180.0%81.0%0.95955.0%65.3%< 0.001
ICU LOS (days)
  Median110.00212< 0.001420.39812< 0.001
  25th percentile00014100
  75th percentile333423736
Total hospital cost ($)
  Median$18,060$23,724< 0.001$16,039$21,019< 0.001$46,747$33,6630.672$22,115$34,255< 0.001
  25th percentile$11,853$15,760$10,445$13,020$33,874$19,305$14,410$18,895
  75th percentile$27,980$40,425$28,980$36,901$109,826$62,475$40,565$64,840
Oral reversal agent cost ($)
  IDA
    Median$3,292$3,320$2,266$3,271
    25th percentile$1,984$1,901$2,093$1,735
    75th percentile$5,145$4,830$4,215$4,809
  PCC
    Median$4,659$4,140$4,872$4,426
    25th percentile$2,698$2,323$2,504$2,555
    75th percentile$7,482$6,829$7,627$7,612