Acep 10-15-13

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Acep 10-15-13

  1. 1. Treatment of Pulmonary Embolism with Rivaroxaban and LMWH-VKA in the Emergency Room Setting: Length of Stay and Economic Implications Brahim K. Bookhart, Lloyd Haskell, Luke Bamber, Maria Wang, Jeff Schein, Samir H. Mody 1
  2. 2. EINSTEIN PE study Randomized, open-label, event-driven, non-inferiority study Predefined treatment period of 3, 6, or 12 months Day 21 Rivaroxaban Confirmed PE with or without symptomatic DVT2 N=4833 Rivaroxaban 15 mg bid 20 mg od N=4833 R Enoxaparin bid for at least 5 days + VKA, INR 2.0–3.0 30-day post-study treatment period Day 1  Primary efficacy outcome: first recurrent VTE  Principal safety outcome: first major or non--major clinically relevant bleeding 1. The EINSTEIN Investigators. N Engl J Med 2010;363:2499–510; 2. The EINSTEIN–PE Investigators. N Engl J Med 2012;366:1287–97
  3. 3. Methods  Examined the North American EINSTEIN PE cohort - United States and Canada  Previous analysis on entire international EINSTEIN PE study presented at American Society of Hematology: found median length of stay difference of 1 day: 6.0 (4.0–9.0) vs. 7.0 (5.0–10.0)  LOS medians and exponentiated least squares mean of logtransformed LOS; nominal P-value was obtained from a Wilcoxon rank-sum test (van Elteren test)  Costs for hospital days were taken from the Healthcare Cost and Utilization Project (HCUP) Family of healthcare databases developed through a federal–state– industry partnership and sponsored by the Agency for Healthcare Research and Quality The average cost per day for PE treatment was $2040 *American Society of Hematology (ASH) 54th Annual Meeting and Exposition, Atlanta, GA, USA; December 8–11, 2012 3
  4. 4. Results Patient population Complete data on hospitalization available, n Hospitalized, n (%) Hospitalized with complete data on length of stay, n Median length of stay, days (interquartile range) Exponentiated LS-mean of log transformed length of stay Rivaroxaban (n=244) Enoxaparin/ VKA (n=242) 244 241 163 (66.8) 160 (66.6) 162 159 3 (3.0–5.0) 4.2 LOS Reduction Pvalue 4 (3.0–6.0) 1.0 0.0002 5.2 1.0 0.0013  Consistent one day reduction in hospitalization associated with $2040 cost savings for rivaroxaban cohort 4

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