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Rapid and substantial increases in anticoagulant use and expenditure in Australia following the introduction of new types of oral anticoagulants

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dc.contributor.authorMorgan, A.
dc.contributor.authorJoshy, G.
dc.contributor.authorSchaffer, A.
dc.contributor.authorLaba, T.L.
dc.contributor.authorLitchfield, M.
dc.contributor.authorPearson, S.
dc.contributor.authorBanks, E.
dc.contributor.editorPhan, T.G.
dc.date.issued2018
dc.description.abstractObjectivesTo 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.
dc.identifier.citationPLoS ONE, 2018; 13(12, article no. e0208824):1-11
dc.identifier.doi10.1371/journal.pone.0208824
dc.identifier.issn1932-6203
dc.identifier.issn1932-6203
dc.identifier.urihttps://hdl.handle.net/11541.2/27423
dc.language.isoen
dc.publisherPublic Library of Science
dc.relation.fundingNHMRC 1060407
dc.relation.fundingHeart Foundation of Australia Partnership Project grant 1092674
dc.relation.fundingNHMRC 1136128 Principal Research Fellowship
dc.relation.fundingNHMRC 1110230 Early Career (Sidney Sax) Fellowship
dc.relation.fundingAustralian Government Research Training Program (RTP) Scholarship
dc.rightsCopyright 2018 The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. (https://creativecommons.org/licenses/by/4.0/)
dc.source.urihttps://doi.org/10.1371/journal.pone.0208824
dc.subjectAustralia
dc.subjectoral anticoagulants
dc.subjectPharmaceutical Benefits Scheme (PBS)
dc.subjectMedicare Australia statistics
dc.titleRapid and substantial increases in anticoagulant use and expenditure in Australia following the introduction of new types of oral anticoagulants
dc.typeJournal article
pubs.publication-statusPublished
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ror.mmsid9916608944201831

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