Comparative Analysis of All-Cause Health Care Resource Utilization and Costs Among Venous Thrombosis Patients Without Cancer Prescribed Apixaban or VKAs in France

Introduction The direct oral anticoagulant (DOAC) apixaban has shown to have non-inferior efficacy and better safety than vitamin K antagonists (VKAs) in patients with venous thromboembolism (VTE). We determined whether healthcare resource use (HCRU) and direct all-cause medical and non-medical costs in patients with VTE in France differed between VKAs and apixaban. Methods A retrospective cohort study was conducted using French national health data from January 2013-June 2018 for anticoagulant-naive adults hospitalized with VTE. All-cause costs and HCRU per patient per month (PPPM) were compared between apixaban and VKA cohorts created by 1:1 propensity score matching. Two-part models with bootstrapping were used to calculate marginal effects for costs and HCRU. Results The matched VKA and apixaban cohorts each comprised 7503 patients. Compared to VKAs, patients prescribed apixaban had significantly lower (P < 0.0001) mean all-cause costs PPPM for outpatient visits (euro438.54 vs. euro455.58), overall laboratory tests (euro21.26 vs. euro83.73), and hospitalizations (euro249.48 vs. euro343.82), but significantly higher (P < 0.0001) mean all-cause costs PPPM for overall drugs (euro97.06 vs. euro69.56) and medical procedures (euro42.12 vs. euro35.50). Mean total all-cause direct medical costs (euro687.93 vs. euro798.70) and total all-cause direct medical and non-medical costs (euro771.60 vs. euro883.66) were significantly lower (P < 0.0001) for apixaban. Mean HCRU PPPM showed similar trends. Subgroup analyses showed that, among patients with recurrent VTE, patients prescribed apixaban had significantly lower (P < 0.0001) all-cause costs PPPM for total medical costs (euro17.26 vs. euro18.12) and total all-cause direct medical and non-medical costs (euro18.37 vs. euro19.20) than patients prescribed VKAs. Similarly, among patients with bleeding, patients prescribed apixaban had significantly lower (P < 0.0001) all-cause costs PPPM for total medical costs (euro15.34 vs. euro32.61) and total all-cause direct medical and non-medical costs (euro16.23 vs. euro34.63) than patients prescribed VKAs. Conclusion Compared to VKAs, apixaban may be cost-saving in the treatment of patients hospitalized for acute VTE.