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. 2025 Apr;31(4):366-376.
doi: 10.18553/jmcp.2025.31.4.366.

Out-of-pocket costs for direct oral anticoagulants and prescription abandonment among patients with nonvalvular atrial fibrillation or venous thromboembolism

Maryia Zhdanava  1 , Veronica Ashton  2 , Jill Korsiak  1 , Fengyi Jiang  1 , Dominic Pilon  1 , Mark Alberts  3
Affiliations

Out-of-pocket costs for direct oral anticoagulants and prescription abandonment among patients with nonvalvular atrial fibrillation or venous thromboembolism

Maryia Zhdanava et al. J Manag Care Spec Pharm. 2025 Apr.

Abstract

Background: Direct oral anticoagulants (DOACs) are used to prevent thrombosis in patients with nonvalvular atrial fibrillation (NVAF) and venous thromboembolism (VTE). Despite their clinical benefits, some patients abandon their DOAC prescription.

Objective: To retrospectively evaluate the association between patient out-of-pocket (OOP) costs and abandonment of the first DOAC prescription among patients with NVAF or VTE in the United States.

Methods: Data from Symphony Health, an ICON plc Company, PatientSource (April 1, 2017, to October 31, 2020) were used to select patients with NVAF or VTE with an approved or abandoned claim for a DOAC (apixaban, dabigatran, rivaroxaban). OOP costs (2021 US dollars) of the index claim were described by abandonment status, and multivariable logistic regression models were used to evaluate the association between OOP costs of the index DOAC claim and abandonment. Analyses were performed in patients with NVAF and VTE separately.

Results: Among 753,755 patients with NVAF, 88.5% had an approved index DOAC claim and 11.5% had an abandoned index DOAC claim. Among 308,429 patients with VTE, 91.5% had an approved index DOAC claim and 8.5% had an abandoned index DOAC claim. Mean OOP costs of the index DOAC claim were lower in those with an approved than abandoned claim (NVAF approved vs abandoned: $79 vs $175; VTE approved vs abandoned: $65 vs $133). Among patients with NVAF, 21.4% of those with an approved claim and 9.1% of those with an abandoned claim had no OOP costs, 58.7% (approved) and 49.0% (abandoned) had OOP costs greater than $0 to less than $100, and 19.9% (approved) and 41.9% (abandoned) had OOP costs greater than or equal to $100; among patients with VTE, 27.8% (approved) and 15.6% (abandoned) had no OOP costs, 58.4% (approved) and 54.8% (abandoned) had OOP costs greater than $0 to less than $100, and 13.8% (approved) and 29.6% (abandoned) had OOP costs greater than or equal to $100. In multivariable models, the risk of abandonment increased by 21% (NVAF) and 17% (VTE) for each $100 in OOP costs (both P < 0.001). Relative to patients with no OOP costs, patients with OOP costs greater than $0 to less than $50 were 86% (NVAF) and 55% (VTE) more likely to abandon their index DOAC, patients with OOP costs greater than $50 to less than $100 were 80% (NVAF) and 111% (VTE) more likely to abandon their index DOAC, and patients with OOP costs greater than or equal to $100 were 332% (NVAF) and 244% (VTE) more likely to abandon their index DOAC (all P < 0.001).

Conclusions: Among patients with NVAF or VTE, OOP costs of the first DOAC claim greater than or equal to $100 were associated with the highest risk of abandoning the first DOAC prescription.

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Conflict of interest statement

This study was funded by Janssen Scientific Affairs, LLC, a Johnson & Johnson company. The study sponsor was involved in several aspects of the research, including the study design, interpretation of data, and writing of the manuscript. Ms Ashton is an employee of Janssen Scientific Affairs, LLC, a Johnson & Johnson company, and holds stock in the company. Ms Zhdanava, Dr Korsiak, Ms Jiang, and Mr Pilon are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, a Johnson & Johnson company, which funded the development and conduct of this study and manuscript. Dr Alberts did not receive compensation for this project.

Figures

FIGURE 1
FIGURE 1
OOP Cost of Index DOAC Claims Among Patients With an Approved or Abandoned Claim
FIGURE 2
FIGURE 2
Multivariable Associations Between OOP Costs and Abandonment of First DOAC Claim in the NVAF Population
FIGURE 3
FIGURE 3
Multivariable Associations Between OOP Costs and Abandonment of First DOAC Claim in the VTE Population
See this image and copyright information in PMC

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