Prior observational studies suggest
rivaroxaban is safe and effective among patients with
morbid obesity who suffered a
venous thromboembolism (VTE) event, but existing data are more limited in the broader population of VTE patients with
obesity. This study assessed VTE recurrence, major
bleeding, healthcare resource utilization, and healthcare costs among VTE patients with
obesity who received
rivaroxaban versus
warfarin. VTE patients with
obesity who initiated
rivaroxaban or
warfarin after a first VTE (index date) were identified from the IQVIA PharMetrics® Plus database (01/02/2011-09/30/2019). The follow-up period spanned from the index date until health plan disenrollment, end of data availability,
cancer diagnosis/treatment, end of the 12 month post-index period, or (for the analysis of major
bleeding)
anticoagulant discontinuation or switch. Patient characteristics were balanced using inverse probability of treatment weighting. The weighted
rivaroxaban (N = 8666) and
warfarin cohorts (N = 5946) were well balanced (mean age = 51 years, females = 52%). Over a 9.6 months mean observation period,
rivaroxaban users had a significantly lower risk of VTE recurrence [7.0% vs. 8.2%, HR(95% CI) = 0.85(0.75;0.97)] and a similar risk of major
bleeding [4.1% vs. 3.6%, HR(95% CI) = 1.11(0.89;1.37)] relative to
warfarin users at 12 months. Relative to
warfarin users,
rivaroxaban users had significantly fewer all-cause outpatient visits [RR(95% CI) = 0.71(0.70;0.74)]. The higher pharmacy costs incurred by
rivaroxaban recipients (cost difference = $1252) were offset by lower medical costs (cost difference = - $2515, all p < 0.05) compared with
warfarin recipients. Our findings suggest that
rivaroxaban is safe and effective versus
warfarin, and associated with lower medical costs among VTE patients with
obesity.