Comparison of real-world outcomes in patients with nonvalvular atrial fibrillation treated with direct oral anticoagulant agents or warfarin

2019 ◽  
Vol 76 (5) ◽  
pp. 275-285 ◽  
Author(s):  
Manasi Datar ◽  
Concetta Crivera ◽  
Heather Rozjabek ◽  
Ibrahim M Abbass ◽  
Yihua Xu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real World ◽  
Oral Anticoagulant ◽  
Direct Oral Anticoagulant ◽  
Nonvalvular Atrial Fibrillation ◽  
Anticoagulant Agents

scholarly journals Patient-specific and healthcare real-world costs of atrial fibrillation in individuals treated with direct oral anticoagulant agents or warfarin

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mikko Pyykönen ◽  
Miika Linna ◽  
Markku Tykkyläinen ◽  
Eric Delmelle ◽  
Tiina Laatikainen
Keyword(s):  
Atrial Fibrillation ◽  
Information System ◽  
Real World ◽  
Average Cost ◽  
Annual Cost ◽  
Oral Anticoagulant ◽  
Healthcare Service ◽  
Warfarin Therapy ◽  
Direct Oral Anticoagulant ◽  
Travel Costs

Abstract Background Anticoagulant therapies are used to prevent atrial fibrillation-related strokes, with warfarin and direct oral anticoagulant (DOAC) the most common. In this study, we incorporate direct health care costs, drug costs, travel costs, and lost working and leisure time costs to estimate the total costs of the two therapies. Methods This retrospective study used individual-level patient data from 4000 atrial fibrillation (AF) patients from North Karelia, Finland. Real-world data on healthcare use was obtained from the regional patient information system and data on reimbursed travel costs from the database of the Social Insurance Institution of Finland. The costs of the therapies were estimated between June 2017 and May 2018. Using a Geographical Information System (GIS), we estimated travel time and costs for each journey related to anticoagulant therapies. We ultimately applied therapy and travel costs to a cost model to reflect real-world expenditures. Results The costs of anticoagulant therapies were calculated from the standpoint of patient and the healthcare service when considering all costs from AF-related healthcare visits, including major complications arising from atrial fibrillation. On average, the annual cost per patient for healthcare in the form of public expenditure was higher when using DOAC therapy than warfarin therapy (average cost = € 927 vs. € 805). Additionally, the average annual cost for patients was also higher with DOAC therapy (average cost = € 406.5 vs. € 296.7). In warfarin therapy, patients had considerable more travel and time costs due the different implementation practices of therapies. Conclusion The results indicated that DOAC therapy had higher costs over warfarin from the perspectives of the patient and healthcare service in the study area on average. Currently, the cost of the DOAC drug is the largest determinator of total therapy costs from both perspectives. Despite slightly higher costs, the patients on DOAC therapy experienced less AF-related complications during the study period.

Abstract 154: Adherence to Rivaroxaban Compared to Other Oral Anticoagulant Agents Among Patients With Non-Valvular Atrial Fibrillation

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Colleen A McHorney ◽  
Veronica Ashton ◽  
François Laliberté ◽  
Guillaume Germain ◽  
Willy Wynant ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Patient Outcomes ◽  
Real World ◽  
Oral Anticoagulant ◽  
Index Date ◽  
Absolute Difference ◽  
Real World Data ◽  
Anticoagulant Agents ◽  
Proportion Of Days Covered ◽  
Adherence To Therapy

Background: Adherence to oral anticoagulant (OAC) agents is important for patients with non-valvular atrial fibrillation (NVAF) to prevent potentially severe adverse events. Objectives: To compare real-world adherence rates for rivaroxaban vs other oral anticoagulant agents (apixaban, dabigatran, and warfarin) among patients with NVAF using claims-based data. Methods: Healthcare claims from the IMS Health Real-World Data Adjudicated Claims database (01/2011-06/2015) were used to assess 6 month adherence rates defined as the percentage of patients with proportion of days covered (PDC) ≥0.8 and ≥0.9. Patients were included if they had ≥2 dispensings of rivaroxaban, apixaban, dabigatran, or warfarin at least 180 days apart (the first was termed as the index date), had > 60 days of supply, had ≥ 6 months of pre-index eligibility, had ≥ 1 AF diagnosis pre-index or at index date, and without valvular involvement. A logistic regression model was used to evaluate adherence to therapy adjusting for sociodemographic and clinical characteristics, insurance type, index month and year, previous OAC use, and mental-health risk factors for non-adherence (e.g., mental disorders, bipolar). Results: A total of 13,645 rivaroxaban, 6,304 apixaban, 3,360 dabigatran, and 13,366 warfarin patients were identified. A significantly higher proportion of rivaroxaban users were adherent to therapy (PDC ≥ 0.8 at 6 months vs apixaban, dabigatran, and warfarin users; Table). After adjustment, the proportion of patients adherent to therapy remained significantly higher for rivaroxaban users vs apixaban (absolute difference [AD]: 5.8%), dabigatran (AD: 9.5%), and warfarin users (AD: 13.6%; all P<0.001; Table). More pronounced differences were found with a PDC ≥0.9 (Table). Conclusion: Among NVAF patients, rivaroxaban was associated with significantly higher adherence rates relative to other OACs, whether using a PDC of ≥0.8 or ≥0.9, which could translate into improved patient outcomes and lower healthcare costs.

scholarly journals Dabigatran for Stroke Prevention in Nonvalvular Atrial Fibrillation: Answers to Challenging “Real-World” Questions

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Jorge Ferreira ◽  
Daniel Ferreira ◽  
Miguel Viana-Baptista ◽  
Paulo Bettencourt ◽  
Rui Cernadas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real World ◽  
Stroke Prevention ◽  
Oral Anticoagulant ◽  
Dabigatran Etexilate ◽  
Direct Thrombin Inhibitor ◽  
Thrombin Inhibitor ◽  
Joint Effort ◽  
Nonvalvular Atrial Fibrillation ◽  
New Oral Anticoagulant

Dabigatran etexilate is a novel, oral, reversible, direct thrombin inhibitor that constitutes a major breakthrough for stroke prevention in patients with nonvalvular atrial fibrillation (AF). Dabigatran was the first new oral anticoagulant approved in Europe and became available in Portugal, for stroke prevention in nonvalvular AF, earlier than in most European countries. This paper is the joint effort of a panel of experts from different specialties and provides information on the use of dabigatran, in anticipation of the challenges that will come with increased usage.

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