Abstract
ObjectivesTo quantify changes in anticoagulant use in Australia since the introduction of Non-vitamin K antagonist anticoagulants (NOACs) and to estimate government expenditure.DesignInterrupted-time-series analysis quantifying anticoagulant dispensing, before and after first Pharmaceutical Benefits Scheme (PBS) NOAC listing in August 2009 for venous thromboembolism prevention; and expanded listing for stroke prevention in non-valvular atrial fibrillation (AF) in August 2013, up to June 2016. Estimated government expenditure on PBS-listed anticoagulants.Setting and participantsPBS dispensing in 10% random sample of Australians, restricted to continuous concessional beneficiaries dispensed oral anticoagulants from July 2005 to June 2016. Total PBS anticoagulant expenditure was calculated using Medicare Australia statistics.Main outcome measuresMonthly dispensing and initiation of oral anticoagulants (warfarin, rivaroxaban, dabigatran or apixaban). Annual PBS anticoagulant expenditure.ResultsAn estimated 149,180 concessional beneficiaries were dispensed anticoagulants (100% warfarin) during July 2005. This increased to 292,550 during June 2016, of whom 47.0%, 27.1%, 18.7% and 7.2% were dispensed warfarin, rivaroxaban, apixaban and dabigatran, respectively. Of 16,500 initiated on anticoagulants in June 2016, 24.3%, 38.2%, 30.0% and 7.5% were initiated on warfarin, rivaroxaban, apixaban, and dabigatran, respectively. Compared to July 2005-July 2013, from August 2013-June 2016, dispensings for all anticoagulants increased by 2,303 dispensings/month (p<0.001, 95%CI = [1,229 3,376]); warfarin dispensing decreased by 1,803 dispensings/month (p<0.001, 95%CI = [–2,606, –1,000]). Total PBS anticoagulant expenditure was $19.5 million (97.0% concessional) in 2008/09, of which 100% was warfarin and $203.3 million (86.2% concessional) in 2015/16, of which 11.2% was warfarin.ConclusionsThe introduction of the NOACs led to substantial increases in anticoagulant use and expenditure in Australia.
Highlights
Thrombotic disorders, including stroke and venous thromboembolism (VTE) contribute to significant morbidity and mortality globally
Anticoagulant use and expenditure in Australia following the introduction of new types of oral anticoagulants
The introduction of the non-vitamin k oral anticoagulants (NOACs) led to substantial increases in anticoagulant use and expenditure in Australia
Summary
Thrombotic disorders, including stroke and venous thromboembolism (VTE) contribute to significant morbidity and mortality globally. Given the significant mortality and morbidity burden of stroke and VTE, effective prophylaxis with oral anticoagulants (OACs), including warfarin, and the non-vitamin k oral anticoagulants (NOACs) is essential. Warfarin is the most extensively used OAC in the world, with 1-2% of adults in the developed world estimated to have been prescribed warfarin [4,5,6,7]. When used optimally, it is highly efficacious, providing a relative risk reduction for stroke in patients with AF of 64% compared to placebo [8]. There are significant risks with taking warfarin: up to 2% of people treated will experience a major bleed, and between 0.1 and 0.5% will have an intracranial bleed [11,12,13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
