OBJECTIVES: Venous thromboembolism (VTE), which can lead to costly complications, is managed using direct-acting oral anticoagulants (DOAC) and low molecular weight heparins (LMWH). While prior randomized controlled trials showed that DOACs are more efficacious than LMWH, it is unclear whether greater efficacy translates to lower economic burden. This study compares healthcare resource utilization (HcRU) and costs among patients with VTE who initiated DOAC or LMWH in the US.

METHODS: We identified adults with VTE who were treated with DOAC or LMWH in the Merative™️ MarketScan® Commercial Dataset(1/1/2016-12/31/2021). Baseline measures were assessed 12 months prior to treatment (index date). We utilized inverse probability of treatment weighting (IPTW) to control for confounding variables, and we used the weighted cohort in the analysis. For HcRU, we utilized logistic regression to model emergency department (ED) visits and inpatient hospitalizations and negative binomial regression to model outpatient visits. A two-part model was utilized to estimate the difference in total direct healthcare costs. HcRU and costs were assessed up to 12 months after treatment initiation. We report adjusted odds ratios (AOR), incident rate ratios (IRR), and 95% confidence intervals (CI) for the binary measure of DOAC initiation.

RESULTS: After IPTW, patients treated with DOAC had lower odds of ED visits (AOR: 0.88, 95% CI: 0.78, 0.99) and inpatient hospitalization (AOR 0.54, 95% CI 0.49, 0.60) compared to LMWH users. DOAC users also had a lower rate of outpatient visits (IRR: 0.53, 95% CI: 0.51, 0.55). DOAC users had lower total healthcare costs than LMWH users, with a mean cost difference of -$9,182 (95% CI -$9,285, -$8,976).

CONCLUSIONS: This study found that managing VTE with DOAC is associated with lower HcRU and costs compared to LMWH, contributing to limited evidence on economic outcomes and potential implications for reimbursement policies. Future observational studies could assess clinical outcomes.