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Published in: American Journal of Cardiovascular Drugs 3/2024

07-04-2024 | Oral Anticoagulant | Original Research Article

Trends in Oral Anticoagulant Use and Individual Expenditures Across the United States from 2014 to 2020

Authors: Omar S. Alkhezi, Leo F. Buckley, John Fanikos

Published in: American Journal of Cardiovascular Drugs | Issue 3/2024

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Abstract

Background

Landmark clinical trials have expended the indications for the direct oral anticoagulants (DOACs), but contemporary data on usage and expenditure patterns are lacking.

Objective

This study aimed to assess annual trends in oral anticoagulant (OAC) utilization and expenditure across the United States (US) from 2014 to 2020.

Methods

We utilized the Medical Expenditure Panel Survey (MEPS) to study the trends of use and expenditures of warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban between 2014 and 2020 in the US. Survey respondents reported OAC use within the past year, which was verified against pharmacy records. Payment information was obtained from the respondent’s pharmacy and was categorized as third-party or self/out-of-pocket. Potential indications and medical conditions of interest for OAC therapy were identified from respondent-reported medical conditions. We estimated the national number of OAC users and total expenditures across age, sex, race, ethnicity, insurance, and medical condition subgroups. Trends of OAC users’ characteristics, expenditure, and number of prescriptions were evaluated using the Mann–Kendall test for trends.

Results

Between 2014 and 2020, the number of warfarin users decreased from 3.8 million (70% of all OAC users) to 2.2 million (= 0.007) [29% of all OAC users], while the number of DOAC users increased from 1.6 million (30% of all OAC users) to 5.4 million (= 0.003) [70% of all OAC users]. The total expenditure of OACs in the US increased from $3.4 billion in 2014 to $17.8 billion in 2020 (= 0.003), which was driven by the increase in DOAC expenditures (= 0.003).

Conclusions

DOACs have replaced warfarin as the preferred OAC in the US. The increased costs associated with DOAC use may decline when generic formulations are approved.
Literature
2.
go back to reference Pradaxa [package insert]. Ridgefield: Boehringer Ingelheim Pharmaceuticals, Inc.; 2023. Pradaxa [package insert]. Ridgefield: Boehringer Ingelheim Pharmaceuticals, Inc.; 2023.
3.
go back to reference Xarelto [package insert]. Titusville: Janssen Pharmaceuticals, Inc.; 2023. Xarelto [package insert]. Titusville: Janssen Pharmaceuticals, Inc.; 2023.
4.
go back to reference Eliquis [package insert]. Princeton: Bristol-Myers Squibb Company; 2021. Eliquis [package insert]. Princeton: Bristol-Myers Squibb Company; 2021.
5.
go back to reference Savaysa [package insert]. Basking Ridge: Daiichi Sankyo, Inc.; 2023. Savaysa [package insert]. Basking Ridge: Daiichi Sankyo, Inc.; 2023.
26.
go back to reference Wong SL, Marshall LZ, Lawson KA. Direct oral anticoagulant prescription trends, switching patterns, and adherence in Texas medicaid. Am J Manag Care. 2018;24(8):SP309-SP314. Wong SL, Marshall LZ, Lawson KA. Direct oral anticoagulant prescription trends, switching patterns, and adherence in Texas medicaid. Am J Manag Care. 2018;24(8):SP309-SP314.
32.
go back to reference Chowdhury SR, Machlin SR GK. Sample designs of the medical expenditure panel survey household component, 1996–2006 and 2007–2016. Methodology Report #33. Rockville: Agency for Healthcare Research and Quality Chowdhury SR, Machlin SR GK. Sample designs of the medical expenditure panel survey household component, 1996–2006 and 2007–2016. Methodology Report #33. Rockville: Agency for Healthcare Research and Quality
33.
go back to reference Hill SC, Roemer M SM. Outpatient prescription drugs: data collection and editing in the 2011 medical expenditure panel survey. Methodology Report #29. Rockville: Agency for Healthcare Research and Quality. Hill SC, Roemer M SM. Outpatient prescription drugs: data collection and editing in the 2011 medical expenditure panel survey. Methodology Report #29. Rockville: Agency for Healthcare Research and Quality.
41.
go back to reference Elshafei MN, Mohamed MFH, El-Bardissy A, et al. Comparative effectiveness and safety of direct oral anticoagulants compared to warfarin in morbidly obese patients with acute venous thromboembolism: systematic review and a meta-analysis. J Thromb Thrombol. 2021;51(2):388–96. https://doi.org/10.1007/s11239-020-02179-4.CrossRef Elshafei MN, Mohamed MFH, El-Bardissy A, et al. Comparative effectiveness and safety of direct oral anticoagulants compared to warfarin in morbidly obese patients with acute venous thromboembolism: systematic review and a meta-analysis. J Thromb Thrombol. 2021;51(2):388–96. https://​doi.​org/​10.​1007/​s11239-020-02179-4.CrossRef
Metadata
Title
Trends in Oral Anticoagulant Use and Individual Expenditures Across the United States from 2014 to 2020
Authors
Omar S. Alkhezi
Leo F. Buckley
John Fanikos
Publication date
07-04-2024
Publisher
Springer International Publishing
Published in
American Journal of Cardiovascular Drugs / Issue 3/2024
Print ISSN: 1175-3277
Electronic ISSN: 1179-187X
DOI
https://doi.org/10.1007/s40256-024-00638-4

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