XARELTO(Rivaroxaban) is associated with Lower Hospital Readmission Rates for Major Joint Replacement Patients at Bethesda Hospital based on Real World Evidence Study of Medicare Claims Data

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In Xarelto, Joint Replacement

By: Sara Riascos  Mar. 03, 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. XARELTO(Rivaroxaban) is a factor XA inhibitor prescribed by doctors to prevent blood clots from irregular heartbeat (atrial fibrillation) or after hip or knee replacement surgery. Studies have shown that the early use of XARELTO(Rivaroxaban) after a Major joint replacement surgery is associated with decreased the rate of symptomatic VTE. Other studies have shown that XARELTO(Rivaroxaban) had a superior effect in THA patients. 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 Major Joint Replacement at Bethesda Hospital at Boynton Beach, Florida. 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 at Bethesda Hospital 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 XARELTO(Rivaroxaban) within 7 Days of Hospitalization using Part D drugs claims database
   2. Major Joint Replacement 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 DRG Diagnosis Codes examined at Bethesda Hospital. For patients whose primary DRG Diagnosis was “Major Joint Replacement or Reattachment of Lower Extremity Without Major Complication or Comorbidity (MCC)” (470) and whenXARELTO(Rivaroxaban) was used within 7 days of hospitalization, the readmission rate was 5% compared to the cohort where XARELTO(Rivaroxaban) was not used, whose readmission rate was 10%. The readmission odds ratio for these cohorts was 0.53. The use of XARELTO(Rivaroxaban) was associated with a 53% 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 XARELTO(Rivaroxaban) for Major Joint Replacement hospitalizations at Bethesda Hospital is shown below.

Primary DRG Diagnosis Code	Primary DRG 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 (+)
470	MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)	1,251

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

DRG CODE	Hospital	Hospitalizations with Major Joint Replacement	% of Hospitalizations without XARELTO(Rivaroxaban)
470	Franciscan Health Olympia Fields	11,680	99.8%
	WILLIAM BEAUMONT HOSPITAL	2,758	99.5%
	CEDARS-SINAI MEDICAL CENTER	2,483	99.4%
	BETHESDA HOSPITAL	1,262	99.1%

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 XARELTO(Rivaroxaban) within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Major Joint Replacement patients at Bethesda Hospital. This analysis shows that a significant number of Patients are not dispensed XARELTO(Rivaroxaban) after Major Joint Replacement hospitalizations at Bethesda Hospital or at major US Hospitals.