Cost of Anticoagulation for Non-Valvular Atrial Fibrillation in Australia

Abstract

Objectives: Since 2013, non-vitamin K antagonist oral anticoagulants (NOACs) have surpassed Warfarin to become the mainstay treatment of non-valvular atrial fibrillation (AF) in Australia. We examine the analogous change in cost of anticoagulation over the past 5 years. Methods: Data were extrapolated from the Pharmaceutical Benefits Scheme (PBS) and Medicare Australia. We examined the total number of scripts and cost of Warfarin and all NOACs- Apixaban, Rivaroxaban, Dabigatran- that were available for non-valvular AF from September 2013 until October 2018. Month-to-month comparisons were made between the cost of all NOACs and Warfarin. INR testing cost was examined over the same period. Results: NOAC prescription in Australia has continued to rise with a 3530% increase from September 2013 to October 2018 corresponding to a 42.8% decline in Warfarin use. Our study further demonstrates a 31.9% decrease in INR testing. Apixaban has now exceeded Rivaroxaban as the most commonly prescribed NOAC (48.2% vs. 40.4%) for non-valvular AF. With the increasing use of NOACs, cost has also increased proportionately by 3400% from $790,569 in September 2013 to $26,902,194 in October 2018. This has corresponded with a 21.9% decrease in cost of Warfarin and INR testing from $7,493,898 to $5,855,804. Conclusions: NOACs have become the drugs of choice for stroke prevention in non-valvular AF in Australia. While use of NOACs has increased cost to the government, cost of Warfarin and INR testing has declined and costs are expected to decrease further when NOAC patents expire in 2020.