Clinical and Economic Outcomes Among Non-Valvular Atrial Fibrillation Patients with Coronary Artery Disease and/or Peripheral Artery Disease.

Abstract 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.