Author + information
- Benjamin Rodwin,
- Khurram Nasir,
- Joseph Salami,
- Erica Spatz,
- Javier Valero-Elizondo,
- Salim Virani,
- Ron Blankstein,
- Michael Blaha and
- Nihar Desai
Background: Little is known about national patterns of anticoagulant use among patients with atrial fibrillation after the availability of direct oral anticoagulants (DOACs) and the associated implications for health care spending.
Methods: The Medical Expenditure Panel Survey, an annual nationally representative survey of individuals as well as their medical providers and employers across the United States, collects detailed information about prescription drug use, cost, and medical diagnoses. Adults with atrial fibrillation between 2010 and 2013 were identified using validated ICD-9 codes. We examined proportions of patients receiving warfarin and DOACs (dabigatran and rivaroxaban) overall and across sociodemographic and clinical groups. Total drug costs and out of pocket spending were calculated across groups.
Results: Over 5.3 million adults with atrial fibrillation were evaluated. Between 2010 and 2013, use of DOACs increased from 0.6% to 11.8% while warfarin use declined from 32.8% to 22.2% (p<0.001). Adults who were male, non-Hispanic Whites, had higher income, and those with the lowest CHA2DS2-VASc scores (0 or 1) were significantly more likely to receive DOACs than warfarin (p<0.001 for all). Prescription drug spending on DOACs increased from $92 million in 2010 to $1.29 billion in 2013 while spending on warfarin declined from $219 million to $128 million. Out of pocket costs for DOACs increased from $10 million to $174 million while decreasing for warfarin from $102 million to $62 million.
Conclusions: In a large, nationwide cohort of adults with atrial fibrillation, we observed a significant increase in use of DOACs, accompanied by declines in warfarin use; the overall use of any anticoagulant remained low. There were marked disparities in the use of DOACs based on sex, race, income and risk of stroke. These patterns have important implications for care quality as well as health care spending.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Arrhythmias and Clinical EP: Basic 1
Abstract Category: 4. Arrhythmias and Clinical EP: Basic
Presentation Number: 1107-075
- 2017 American College of Cardiology Foundation