WASHINGTON, D.C.—Johnson & Johnson’s Xarelto (rivaroxaban), Boehringer Ingelheim’s Pradaxa (dabigatran) and Pfizer and Bristol-Myers Squibb’s Eliquis (apixaban) all topped warfarin on some safety measures in a recent real-world study. But only one of the next-gen anticoagulants showed it could save the healthcare system hundreds of dollars per patient in the process.
According to data from a study of U.S. Medicare patient records, comparing the newer meds with standby warfarin, Pradaxa patients displayed a similar risk of stroke but a significantly lower risk of major bleeding; Xarelto patients were at a significantly lower risk of stroke but significantly higher risk of major bleeding; and Eliquis patients had a significantly lower risk of both. The analyses were presented Friday and Saturday at the American College of Cardiology annual meeting
The differences in cost read-through were noticeable, too. In stacking up the costs from major bleeding-related events, the study found that Xarelto racked up $542 per patient, compared with warfarin’s $500, or $42 more. Pradaxa, in its own head-to-head against warfarin, cost $367 to warfarin’s $452, saving $85. But Eliquis took the cake, posting a $286 charge against warfarin’s $537 to post $251 in savings.
“When I sit back and I look at this from a triple aim perspective, what they want us to do is design healthcare systems and healthcare delivery that improves quality, improves safety, decreases costs and improves patient or customer experience,” lead study investigator Alpesh Amin said in an interview. “It appears in the real world that apixaban is doing that.”
And the way he sees it, insurance companies won’t have trouble finding ways to use the data.
“Formularies ... can use this to say, ‘hey, if the goal of healthcare is to reduce overall cost burden, then I should be choosing technology and therapeutics that help me do that,” he said.
Of course, real-world data can have its limitations, he acknowledged. For one, they’re usually claims-based, leaving the data susceptible human error during the uploading and coding process.
But they have their advantages, too, Cristina Masseria, Pfizer senior director of outcomes and evidence, said in a separate interview. She likened controlled clinical trials to eating dinner at home, where she tells her children to be polite and use a fork and knife. But “when they go outside, I don’t know if they’re going to do the same or not,” making it important to study real-world evidence, too.
“It’s our commitment to show the real value of our medicine and to provide the physicians, patients and payers the full totality of information to make an informed decision when they need to prescribe an anticoagulant for a patient with atrial fibrillation,” she said, adding, “By reducing the cost of the bleeding and the stroke event, you can offset the pharmaceutical cost, and this is a very important message.”
Pfizer and BMS, which have been steadily gaining on Xarelto in the market-share race, would love nothing more than for insurers to take that message to heart. “The next phase of growth for Eliquis” will come from nabbing the lead spot in the total prescriptions ranking, Bristol CEO Giovanni Caforio said in January at the J.P. Morgan Healthcare Conference. “[W]e think we are relatively close to achieving that,” he said.
But a high percentage of patients are still using the less convenient warfarin, and that means the market-share battle is still anybody’s game. In its Q3 presentation last October, J&J told investors that 54% of patients were still on the old-guard therapy, with one big reason being that the crop of new-age meds—save Pradaxa—has no reversal agent to stop severe bleeding in an emergency.