Length of Hospital Stay Associated with Dabigatran and Warfarin

New Orleans—A retrospective cohort study found that patients with atrial fibrillation (AF) who took dabigatran did not have a significant reduction in length of stay in a hospital compared with those who took warfarin. However, the authors found that a hospital would save $766 per patient treated with dabigatran compared with warfarin due to the fewer days spent hospitalized. Results were presented at the ASHP meeting in a poster titled Pharmacoeconomic Evaluation of Dabigatran Compared to Warfarin for Stroke Prophylaxis in Atrial Fibrillation. AF affects 2.3 million people in the United States and accounts for 105,000 strokes each year. Warfarin, a vitamin K epoxide reductase inhibitor, is the standard of care in preventing embolism in patients with AF, but patients are required to be monitored extensively because of the high risk of bleeding. Dabigatran is a direct thrombin inhibitor approved by the US Food and Drug Administration in October 2010 to prevent strokes and blood clots in patients with nonvalvular AF. The authors noted that dabigatran costs more than generic warfarin, but the drug does not require monitoring and has been found to lead to fewer major adverse events and better stroke prevention. In the multicenter, multinational, open-label RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, patients received 110 mg or 150 mg of dabigatran twice daily in a blinded fashion or warfarin administered in an unblinded manner. The warfarin was adjusted to maintain an international normalized ratio (INR) between 2.0 and 3.0. The authors concluded that patients who took 150 mg of dabigatran had lower rates of stroke and systemic embolism compared with the warfarin group. Both cohorts had similar rates of major hemorrhage. In this analysis, the authors compared the length of stay of patients at Morristown Medical Center in Morristown, New Jersey, who were admitted to the hospital with a primary diagnosis of AF during the first quarter of 2011 and treated with warfarin at a targeted INR between 2.0 and 3.0 with patients who took 150 mg of dabigatran twice daily. They calculated the mean length of stay and standard deviation to determine potential cost savings associated with dabigatran. Between January 1, 2011, and March 31, 2011, 18 patients at the hospital received dabigatran and 88 received warfarin. According to the authors’ analysis, dabigatran costs $5.86 per patient-day, although the drug does not require monitoring. Warfarin costs $0.04 per patient-day, but it also costs $4.00 per patient-day for INR and/or prothrombin time monitoring. The mean length of stay was 2.93 days for patients taking dabigatran compared with 3.73 days for warfarin, but the 0.80-day difference was not statistically significant (P=.12). The mean cost per hospital stay was $3569.61 in the warfarin group compared with $2804.01 in the dabigatran group. On an annual basis, a hospital would save $269,632 by treating patients with dabigatran rather than warfarin, according to the authors. The authors noted that they had a small sample, which could be seen as a limitation. They suggested another study with more patients and a longer follow-up could better determine whether there is a hospital cost-avoidance advantage associated with dabigatran when compared with warfarin.