Patient-reported treatment satisfaction and budget impact with rivaroxaban vs. standard therapy in elective cardioversion of atrial fibrillation: a post hoc analysis of the X-VeRT trial.

Stefan H Hohnloser, Riccardo Cappato, Michael D Ezekowitz, Thomas Evers, Kurtulus Sahin, Paulus Kirchhof, Isabelle Ling Meng, Martin van Eickels, A John Camm

Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2016;18(2):184-90

PMID: 26487668

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Abstract

AIMS

We compared patient-reported treatment satisfaction and the economic impact of anticoagulation therapy with rivaroxaban vs. vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation undergoing elective cardioversion procedures.

METHODS AND RESULTS

The current study is a post hoc analysis of the prospective, multicentre X-VeRT (EXplore the efficacy and safety of once-daily oral riVaroxaban for the prevention of caRdiovascular events in subjects with non-valvular aTrial fibrillation scheduled for cardioversion) trial. Patient-reported treatment satisfaction with anticoagulation therapy was assessed using the Treatment Satisfaction Questionnaire for Medication version II in seven countries (US, UK, Canada, Germany, France, Italy, and the Netherlands). An economic model was also developed to estimate the impact of postponed cardioversions for two countries (UK and Italy). This model estimated the total costs of cardioversion, taking into consideration the costs for drug therapy (including extended treatment duration due to cardioversion postponement), international normalized ratio monitoring of VKAs, the cardioversion procedure, and rescheduling the procedure. These costs were linked to the respective X-VeRT study data to estimate the total costs. Patients receiving rivaroxaban in the delayed cardioversion group had significantly higher scores for Convenience, Effectiveness, and Global satisfaction (81.74 vs. 65.78; 39.41 vs. 32.95; and 82.07 vs. 66.74, respectively; P < 0.0001). Based on the total patient population included in the treatment satisfaction substudy (n = 632) in the delayed cardioversion group in X-VeRT, the use of rivaroxaban was estimated to result in a saving of £421 and €360 per patient in UK and Italian settings, respectively.

CONCLUSION

The use of rivaroxaban in the setting of cardioversion resulted in greater patient satisfaction and cost savings, compared with that of VKA.

Address: Department of Cardiology, Division of Clinical Electrophysiology, J.W. Goethe University, Frankfurt, Germany [email protected].; Arrhythmia and Electrophysiology Center, IRCCS Humanitas Research Hospital, Milan, Italy Humanitas Gavazzeni Hospital, Bergamo, Italy.; The Sidney Kimell Medical College at Thomas Jefferson University, Philadelphia, PA, USA.; Bayer Pharma AG, Wuppertal, Germany.; ClinStat GmbH, Statistics and Health Economics, Cologne, Germany.; Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, University of Birmingham, SWBH and UHB NHS Trusts, Birmingham, UK Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany.; Global Medical Affairs, Bayer HealthCare, Berlin, Germany.; Division of Clinical Sciences, St George's, University of London, London, UK.

DOI: 10.1093/europace/euv294

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MeSH Terms: Aged, Anticoagulants, Atrial Fibrillation, Budgets, Canada, Cost Savings, Cost-Benefit Analysis, Drug Costs, Electric Countershock, Europe, Factor Xa Inhibitors, Female, Humans, Male, Middle Aged, Models, Economic, Patient Satisfaction, Prospective Studies, Rivaroxaban, Stroke, Surveys and Questionnaires, Time Factors, Treatment Outcome, United States, Vitamin K, Warfarin