Incremental economic burden associated with major bleeding among atrial fibrillation patients treated with factor Xa inhibitors

J Med Econ. 2017 Dec;20(12):1217-1223. doi: 10.1080/13696998.2017.1362412. Epub 2017 Aug 11.


Objective: To evaluate healthcare resource use and costs incurred during, as well as following hospitalization for major bleeding (MB), among atrial fibrillation (AF) patients treated with factor Xa inhibitors Methods: Patients with an AF diagnosis and MB hospitalization (index event) were identified from the MarketScan Commercial and Medicare databases (January 1, 2011-December 31, 2014). Patients were required to have ≥1 prescription for rivaroxaban or apixaban within 3 months prior to MB hospitalization. AF patients treated with Xa inhibitors, but who did not have any diagnosis of MB during the study period were identified. Hospital resource use and costs were evaluated for index MB hospitalizations. Healthcare resource use and associated costs were also evaluated for up to 12 months and compared between AF patients with and without MB.

Results: Of the overall patient population with AF treated with factor Xa inhibitors (n = 92,949), 3,081 (3.3%) were identified as patients with MB and 89,868 without MB. The mean hospital length of stay and hospital cost for index MB hospitalizations were 5.3 days and $28,059, respectively. Total all-cause healthcare costs were higher during the 12 months of follow-up for AF patients with MB vs without ($63,866 vs $37,916, p < .001). After adjusting for differences in patient characteristics, mean total healthcare costs were estimated at $58,169 for patients with MB vs $41,241 for patients without MB.

Limitations: Since this was an observational study using a claims database analysis, a causal relationship between factor Xa inhibitor treatment and MB events cannot be inferred from the results of this study.

Conclusion: In the real-world setting, the cost of initial hospitalizations for MB was substantial, and the incremental burden of total healthcare costs within 1 year following MB hospitalization was high. Approaches to better manage the continuum of care of AF patients with factor Xa inhibitor-associated MB may reduce the healthcare economic burden.

Keywords: Atrial fibrillation; factor Xa inhibitors; healthcare cost; healthcare resource use; major bleeding.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Atrial Fibrillation / drug therapy*
  • Factor Xa Inhibitors / adverse effects*
  • Factor Xa Inhibitors / therapeutic use
  • Female
  • Health Resources / economics
  • Health Resources / statistics & numerical data
  • Hemorrhage / chemically induced*
  • Hemorrhage / economics*
  • Hospitalization / economics
  • Humans
  • Insurance Claim Review
  • Male
  • Middle Aged
  • Pyrazoles / therapeutic use
  • Pyridones / therapeutic use
  • Retrospective Studies
  • Rivaroxaban / therapeutic use
  • United States
  • Young Adult


  • Anticoagulants
  • Factor Xa Inhibitors
  • Pyrazoles
  • Pyridones
  • apixaban
  • Rivaroxaban