Featured Research

from universities, journals, and other organizations

Novel oral anticoagulant prescriptions soar, but at a high cost

Date:
August 20, 2014
Source:
Elsevier
Summary:
Warfarin, the longtime standard treatment for atrial fibrillation, is facing competition from new options in the anticoagulant drug marketplace including dabigatran, rivaroxaban, and apixaban. A new study documents the rapid adoption of these novel oral anticoagulants (NOACs) into clinical practice. By mid-2013 NOACs accounted for 62% of all new anticoagulant prescriptions yet this represents 98% of total anticoagulant-related drug costs.

Warfarin, the longtime standard treatment for atrial fibrillation, is facing competition from new options in the anticoagulant drug marketplace including dabigatran, rivaroxaban, and apixaban. A new study documents the rapid adoption of these novel oral anticoagulants (NOACs) into clinical practice. By mid-2013 NOACs accounted for 62% of all new anticoagulant prescriptions yet this represents 98% of total anticoagulant-related drug costs. Findings are published in The American Journal of Medicine.

Related Articles


Atrial fibrillation (AF) is a serious heart arrhythmia that can increase a patient's risk for stroke and blood clots. For many years warfarin has been the only anticoagulant available to patients with AF. Relatively inexpensive, warfarin was effective, but not well tolerated by patients because of necessary routine monitoring, dietary restrictions, and increased bleeding risks, especially in older patients. Recently, a group of NOACs has been approved by the FDA, which includes dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis). These new medications require no monitoring and have been shown to work just as well or better than warfarin in randomized trials.

Commenting on the study, Joseph S. Alpert, MD, Professor of Medicine, University of Arizona College of Medicine, Tucson, writes that "Given the much simpler clinical protocol associated with a NOAC, it is not surprising that the NOACs accounted for 62% of new anticoagulant prescriptions during that time period. Ease of use undoubtedly accounted for this rapid switch from warfarin to a NOAC."

In order to better understand NOAC adoption and prescription trend, researchers analyzed medical and prescription claims data from a large American medical insurance company. They identified patients with AF who were prescribed an oral anticoagulant from 2010-2013 and found that during that time period, NOACs accounted for 62% of new prescriptions, meaning that physicians are rapidly adopting NOACs as an acceptable alternative to warfarin, particularly among patients with lower CHADS2 (Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, Stroke) scores and HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly [Age >65 years], Drugs/alcohol concomitantly) scores.

While being prescribed with increasing frequency, the study determined that NOACs were less likely to be given to women and people in lower income areas. Researchers also identified that NOACs were most regularly prescribed to patients with lower CHADS2 and HAS-BLED scores, while warfarin was still being used for those with higher scores. Researchers note that this is significant because in the clinical trials conducted to approve NOACs, most patients had CHADS2 scores in the higher ranges.

"The greatest absolute benefit from novel anticoagulants has been shown in clinical trials to be among patients at highest baseline risk for stroke or systemic embolization, which is at odds with our observation of selection of seemingly lower-risk patients for these drugs," observes lead investigator Niteesh K. Choudhry, MD, PhD, Associate Professor of Medicine at Harvard Medical School and an Associate Physician in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital, Boston. "Such a finding may reflect provider conservatism for new drug adoption, particularly given longitudinal experience with warfarin."

But these new drugs come at a price and high health care cost consequences. The data revealed that NOACs represented 98% of the total dollars spent on anticoagulants from 2010 to 2013. Specifically, over the first six months, the average combined patient and insurer cost associated with starting a NOAC was $900 greater than the costs of starting warfarin, meaning the burden for both insurance and patients is much higher with NOACs.

"The observed patterns of anticoagulant initiation among patients with atrial fibrillation additionally have important economic implications for patients, payers, and the health care system," notes Dr. Choudhry. "Average patient out-of-pocket and insurance spending was more than 5-fold and 15-fold higher, respectively, for novel anticoagulants as compared with warfarin. A 6-month difference in total costs of $900 in our cohort translates into billions of dollars at a national level."

While the rapid adoption of NOACs is good news for patients and doctors who would like more AF medication choices, this study indicates that more information may be needed to fully understand the implications of rising NOAC prescriptions.

"These findings point to the need to conduct ongoing surveillance of the adoption of new agents into clinical practice, as well as the need for robust, real-world comparative-effectiveness analyses of these medications, to enable patients and providers to make informed decisions about their relative benefit, safety, and cost-effectiveness," concludes Dr. Choudhry.

Dr. Alpert expects that the utilization of the NOACs will increase over time, cost will gradually become less of an issue, particularly once they become generic, and new protocols will be devised to minimize, but never eliminate, bleeding risk.


Story Source:

The above story is based on materials provided by Elsevier. Note: Materials may be edited for content and length.


Journal References:

  1. Nihar R. Desai, Alexis A. Krumme, Sebastian Schneeweiss, William H. Shrank, Gregory Brill, Edmund J. Pezalla, Claire M. Spettell, Troyen A. Brennan, Olga S. Matlin, Jerry Avorn, Niteesh K. Choudhry. Patterns of Initiation of Oral Anticoagulants in Patients with Atrial Fibrillation – Quality and Cost Implications. The American Journal of Medicine, 2014; DOI: 10.1016/j.amjmed.2014.05.013
  2. Joseph S. Alpert. The NOACs (Novel Oral Anticoagulants) have landed!. The American Journal of Medicine, 2014; DOI: 10.1016/j.amjmed.2014.07.028

Cite This Page:

Elsevier. "Novel oral anticoagulant prescriptions soar, but at a high cost." ScienceDaily. ScienceDaily, 20 August 2014. <www.sciencedaily.com/releases/2014/08/140820091257.htm>.
Elsevier. (2014, August 20). Novel oral anticoagulant prescriptions soar, but at a high cost. ScienceDaily. Retrieved December 21, 2014 from www.sciencedaily.com/releases/2014/08/140820091257.htm
Elsevier. "Novel oral anticoagulant prescriptions soar, but at a high cost." ScienceDaily. www.sciencedaily.com/releases/2014/08/140820091257.htm (accessed December 21, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Sunday, December 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

The Best Tips to Curb Holiday Carbs

The Best Tips to Curb Holiday Carbs

Buzz60 (Dec. 19, 2014) It's hard to resist those delicious but fattening carbs we all crave during the winter months, but there are some ways to stay satisfied without consuming the extra calories. Vanessa Freeman (@VanessaFreeTV) has the details. Video provided by Buzz60
Powered by NewsLook.com
Sierra Leone Bikers Spread the Message to Fight Ebola

Sierra Leone Bikers Spread the Message to Fight Ebola

AFP (Dec. 19, 2014) More than 100 motorcyclists hit the road to spread awareness messages about Ebola. Nearly 7,000 people have now died from the virus, almost all of them in west Africa, according to the World Health Organization. Video provided by AFP
Powered by NewsLook.com
Researchers Test Colombian Village With High Alzheimer's Rates

Researchers Test Colombian Village With High Alzheimer's Rates

AFP (Dec. 19, 2014) In Yarumal, a village in N. Colombia, Alzheimer's has ravaged a disproportionately large number of families. A genetic "curse" that may pave the way for research on how to treat the disease that claims a new victim every four seconds. Duration: 02:42 Video provided by AFP
Powered by NewsLook.com
The Best Protein-Filled Foods to Energize You for the New Year

The Best Protein-Filled Foods to Energize You for the New Year

Buzz60 (Dec. 19, 2014) The new year is coming and nothing will energize you more for 2015 than protein-filled foods. Fitness and nutrition expert John Basedow (@JohnBasedow) gives his favorite high protein foods that will help you build muscle, lose fat and have endless energy. Video provided by Buzz60
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins