Eliquis/Apixaban is associated with Lower Hospital Readmission Rates for Major Joint Replacement Patients at Cedars-Sinai Medical Center based on Real World Evidence Study of Medicare Claims Data

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In Eliquis

By: Sara Riascos  Feb. 17, 2022

Background:

Major Joint Replacement is frequently associated with hospital readmission. Readmission is a hospital quality measure that reflects dimensions of quality of inpatient care and also impacts overall programs by payers such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing. Eliquis (Apixaban) is an anticoagulant prescribed by doctors to reduce the risk of stroke caused by blood clots. Studies have shown that the early use of Eliquis (Apixaban) after a Major joint replacement surgery is associated with lower rates of clinically relevant bleeding. Other studies have shown that Eliquis reduces the risk of blood clots forming in lungs and legs after undergoing a Major Joint Replacement surgery. Dexur’s analysis of Real-World Evidence based on Medicare Claims data showed that the use of Eliquis (Apixaban) within 7 days of hospitalization was associated with lower hospital readmission rates for Major Joint Replacement at Cedars-Sinai Medical Center. Reduction in readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an approved entity to perform Medicare claims data analysis, which it uses to perform quality outcomes analysis. Dexur has published several papers with Harvard Medical School on quality outcomes related topics. Dexur’s analysis of Drugs and their impact on quality outcomes, such as readmissions and mortality, are used by Hospitals, IDNs, and ACOs to implement best practices and manage Real World Evidence based risk factors.

Methods:

We conducted a retrospective study using Dexur’s analysis of Real-World Evidence from Medicare Claims data, for hospitalizations between January 2017 to September 2019. Our methodology criteria was as follows:

1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Major Joint Replacement codes (Listed in table below)
2. Stratified Selected population into cohorts
   1. Major Joint Replacement patients who dispensed Eliquis (Apixaban) within 7 Days of Hospitalization using Part D drugs claims database
   2. Major Joint Replacement patients who did not dispense Eliquis (Apixaban) within 7 Days of Hospitalization
3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Eliquis (Apixaban) was associated with lower hospital readmission rates for all Primary DRG Diagnosis Codes examined at Cedars-Sinai Medical Center. For patients whose primary DRG Diagnosis was “Major Joint Replacement or Reattachment of Lower Extremity Without Major Complication or Comorbidity (MCC)” (470) and when Eliquis (Apixaban) was used within 7 days of hospitalization, the readmission rate was 7% compared to the cohort where Eliquis (Apixaban) was not used, whose readmission rate was 13%. The readmission odds ratio for these cohorts was 0.51. The use of Eliquis (Apixaban) was associated with a 6% lower readmission rate when used within 7 days of hospitalization. The full list of studied DRG codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Eliquis (Apixaban) for Major Joint Replacement hospitalizations at Cedars-Sinai Medical Center is shown below.

Primary DRG Diagnosis Code	Primary DRG Diagnosis Code Description	Total Hospitalizations without Eliquis	Readmission without Eliquis	Readmission Rate without Eliquis	Total Hospitalizations with Eliquis	Readmission with Eliquis	Readmission Rate with Eliquis	Readmission Odds Ratio	Reduction in Readmission with Eliquis (%)	Confidence Interval (-)	Confidence Intervals (+)
470	MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)	2,472

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Major Joint Replacement at major Hospitals were not prescribed Eliquis within 7 days of discharge.

DRG CODE	Hospital	Hospitalizations with Major Joint Replacement	% of Hospitalizations without Eliquis
470	MCBRIDE CLINIC ORTHOPEDIC HOSPITAL	3,100	99.4%
	CEDARS-SINAI MEDICAL CENTER	2,483	99.6%
	ST. JOHN BROKEN ARROW	1,350	98.9%

Hospitalizations with Major Joint Replacement = Above Listed DRG Codes

Conclusions:

According to analysis of Real-World Evidence of Medicare Claims data, for hospitalizations between January 2017 to September 2019, the use of Eliquis (Apixaban) within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Major Joint Replacement patients at Cedars-Sinai Medical Center. This analysis shows that a significant number of Patients are not dispensed Eliquis (Apixaban) after Major Joint Replacement hospitalizations at Cedars-Sinai Medical Center or at major US Hospitals.