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. 2016 Mar;22(3):281-92.
doi: 10.18553/jmcp.2016.22.3.281.

Evaluating the Initiation of Novel Oral Anticoagulants in Medicare Beneficiaries

Seo Hyon Baik  1 , Inmaculada Hernandez  2 , Yuting Zhang  3
Affiliations

Evaluating the Initiation of Novel Oral Anticoagulants in Medicare Beneficiaries

Seo Hyon Baik et al. J Manag Care Spec Pharm. 2016 Mar.

Abstract

Background: As alternatives to warfarin, 2 novel oral anticoagulants (NOACs), dabigatran and rivaroxaban, were approved in 2010 and 2011 to prevent stroke and other thromboembolic events in patients with atrial fibrillation. It is unclear how patient characteristics are associated with the initiation of anticoagulants.

Objective: To evaluate how patient demographics, clinical characteristics, types of insurance, and patient out-of-pocket spending affect the initiation of warfarin and 2 NOACs--dabigatran and rivaroxaban.

Methods: We used pharmacy claims data from a 5% random sample of Medicare beneficiaries to identify patients who were newly diagnosed with atrial fibrillation between October 1, 2010, and October 31, 2012, and who were prescribed an oral anticoagulant within 60 days of diagnosis. We identified key predictors of initiation of NOACs using a multinomial logistic regression model with generalized logit link.

Results: Patients who were black and who had a history of acute myocardial infarction, stroke or transient ischemic attack, chronic kidney disease, or congestive heart failure were significantly associated with lower odds of receiving NOACs compared with warfarin. Age greater than 65 years, a history of hypertension, and use of nonsteroidal anti-inflammatory drugs were positively associated with the initiation of NOACs. Rivaroxaban was most likely to be initiated among women, followed by warfarin and dabigatran. Individuals receiving a low-income subsidy were more likely to initiate warfarin than NOACs, even though they paid little copayment. Individuals with supplemental Part D drug coverage, such as national Programs for All-Inclusive Care for the Elderly or employer-sponsored plans, were more likely to initiate NOACs compared with warfarin.

Conclusions: We found that race, sex, type of Part D plans, and some clinical conditions were associated with the initiation of NOACs relative to warfarin. But patient demographic and clinical characteristics did not appear to affect which particular NOAC patients initiated.

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Conflict of interest statement

The authors declare no conflict of interest. Biak was senior statistician in the Department of Health Policy and Management, University of Pittsburgh, at the time this study was conducted.

Figures

FIGURE 1
FIGURE 1
Deposition of Study Population
FIGURE 2
FIGURE 2
Comparing Odds of Initiating Warfarin and Dabigatran
FIGURE 3
FIGURE 3
Comparing Odds of Initiating Warfarin and Rivaroxaban
FIGURE 4
FIGURE 4
Comparing Odds of Initiating Dabigatran and Rivaroxaban
See this image and copyright information in PMC

References

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    1. U.S. Food and Drug Administration . Drug approval package—Xarelto (Rivaroxaban). Approval date November 4, 2011. Available at: http://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/202439toc.cfm. Accessed December 5, 2015.
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