The PIONEER AF-PCI trial demonstrated that in
atrial fibrillation patients who underwent intracoronary stenting, either
rivaroxaban 15 mg daily plus P2Y12 inhibitor monotherapy (Group 1) or 2.5 mg
rivaroxaban twice daily plus dual antiplatelet
therapy (
DAPT) (Group 2) was associated with fewer recurrent hospitalizations, primarily for
bleeding and cardiovascular events, compared with standard-of-care
vitamin K antagonist and
DAPT (Group 3). Associated costs are unknown. This study estimates costs associated with
rivaroxaban strategies compared with
vitamin K antagonist and
DAPT. Medication costs were estimated using wholesale acquisition costs, medication discontinuation rates, and costs of monitoring. Using a large US healthcare claims database, the mean adjusted increase in 1-year cost of care for individuals with
atrial fibrillation and
percutaneous coronary intervention (PCI) rehospitalized for
bleeding, cardiovascular, and other events was compared with those not rehospitalized. Using adjudicated
rehospitalization rates from PIONEER AF-PCI, cost differences were estimated. Rates of
rehospitalization for
bleeding were 6.5%, 5.4%, 10.5%, and 20.3%, 20.3%, 28.4% for cardiovascular events in Groups 1, 2, and 3. Medication and monitoring costs were $3,942, $4,115, and $1,703. One-year costs for all recurrent hospitalization costs and/or patient for the groups were $24,535, $20,205, and $29,756. One-year cost increase associated with
bleeding rehospitalizations and/or patient was $4,160, $3,212, and $6,876 and was $13,264, $11,545, and $17,220 for cardiovascular
rehospitalizations and/or patient. Overall estimated cost per patient was $28,476, $24,320, and $31,458. Compared with
warfarin, both
rivaroxaban treatment strategies had higher medication costs, but these were more than accounted for by fewer hospitalizations.