XARELTO (Rivaroxaban) is associated with Lower Hospital Readmission Rates for Atrial fibrillation (AFib) Patients based on Real World Evidence Study of Medicare Claims Data

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In Xarelto, Pulmonary

Background:

Atrial fibrillation (AFib) 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. XARELTO (Rivaroxaban) is a Factor XA inhibitor that helps reduce the risk of blood clots in conditions like atrial fibrillation (AFib), deep vein thrombosis (DVT), and pulmonary embolism (PE) . Studies have shown that the use of XARELTO (Rivaroxaban) was associated with shorter Length of Stay (LOS) and decreased costs for patients with Low-Risk Pulmonary Embolism (PE). Two studies have confirmed XARELTO’s (rivaroxaban) positive benefit-risk profile in treating venous thromboembolism (VTE), reducing blood clots, and reducing the risk of recurrence. Dexur’s analysis of Real-World Evidence based on Medicare Claims data showed that the use of XARELTO (Rivaroxaban) within 7 days of hospitalization was associated with lower hospital readmission rates for atrial fibrillation (AFib). 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 2019 to September 2019. Our methodology criteria was as follows:

1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with and atrial fibrillation (AFib) codes (Listed in table below)

2. Stratified Selected population into cohorts

   1. Atrial fibrillation (AFib) patients who dispensed XARELTO (Rivaroxaban) within 7 Days of Hospitalization using Part D drugs claims database

   2. Atrial fibrillation (AFib) patients who did not dispense XARELTO (Rivaroxaban) within 7 Days of Hospitalization

3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, XARELTO (Rivaroxaban) was associated with lower hospital readmission rates for all Primary ICD Diagnosis Codes examined. For patients whose primary ICD Diagnosis was “Paroxysmal atrial fibrillation” (I480) and when XARELTO (Rivaroxaban)was used within 7 days of hospitalization, the readmission rate was 17.94% compared to the cohort where XARELTO (Rivaroxaban) was not used, whose readmission rate was 20.42%. The readmission odds ratio for these cohorts was 0.85. The use of XARELTO (Rivaroxaban) was associated with a 15% lower readmission rate when used within 7 days of hospitalization. The full list of studied ICD codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with XARELTO (Rivaroxaban) is shown below.

Primary ICD Diagnosis Code	Primary ICD Diagnosis Code Description	Total Hospitalizations without XARELTO	Readmission Without XARELTO	Readmission Rate without XARELTO	Total Hospitalizations with XARELTO	Readmission with XARELTO	Readmission Rate with XARELTO	Readmission Odds Ratio	Reduction in Readmission with XARELTO (%)	Confidence Interval (-)	Confidence Intervals (+)
I480	Paroxysmal atrial fibrillation	66,812	13,646	20.42%	2,118	380	17.94%	0.85	15%	-2.63%	-2.34%
I4891	Unspecified atrial fibrillation
I481	Persistent atrial fibrillation

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Atrial Fibrillation (AFib) at major Hospitals were not prescribed XARELTO (Rivaroxaban) within 7 days of discharge.

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ICD CODE	Hospital	Hospitalizations with PE	% of Hospitalizations without Xarelto
I480	Arkansas Heart Hospital, LITTLE ROCK, AR, 72211	226	95.58%
	Methodist Hospital, SAN ANTONIO, TX, 78229	221	95.48%
	AdventHealth Orlando, ORLANDO, FL, 32803	215	95.35%
I4891	AdventHealth Orlando, ORLANDO, FL, 32803	219	95.43%
	St. David's Medical Center, AUSTIN, TX, 78705	148	93.24%
	Methodist Hospital, SAN ANTONIO, TX, 78229	147	93.20%
I481	Cleveland Clinic, CLEVELAND, OH, 44195	178	94.38%
	Arkansas Heart Hospital, LITTLE ROCK, AR, 72211	150	93.33%
	Sarasota Memorial Hospital, SARASOTA, FL, 34239	148	93.24%

Conclusions:

According to analysis of Real-World Evidence of Medicare Claims data, for hospitalizations between January 2019 to September 2019, the use of XARELTO (Rivaroxaban) within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of atrial fibrillation (AFib) patients.