Yearly DOACs spend ‘now exceeds €51m’

The introduction of direct oral anticoagulants (DOACs) to the Irish drugs market has resulted in an overall increase in anticoagulant prescribing, according to a recent study.

Researchers also said there has been a significant reduction in warfarin usage, with the annual expenditure on DOACs now exceeding €51 million.

In a paper published in the Irish Medical Journal (IMJ) recently, Smith and Barry said they wanted to investigate the impact of DOACs on the utilisation and expenditure on oral anticoagulants (OACs) in the Irish Community healthcare setting.

Using anonymised prescription data from the Health Service Executive’s pharmacy claims database, they investigated anticoagulant prescribing between January 1, 2014, and December 31, 2018.

Drugs were coded according to World Health Organization-Anatomical Therapeutic Chemical (WHO-ATC) classification.

Anticoagulant drugs were identified using the relevant ATC codes i.e. warfarin (B01AA03), dabigatran (B01AE07), rivaroxaban (B01AF01, B01AX06), apixaban (B01AF02), and edoxaban (B01AFO3), and extracted from the database.

“Patients were categorised into the following age groups: 0-44, 45-64, 65-79 and 80 years or over to determine utilisation in the different age cohorts,” they wrote.

Drugs that were contraindicated or cautioned in combination with DOACs were also identified including: nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, amiodarone, verapamil, systemic antimycotics and antidepressants, they added.

The results showed that during the trial period, 74,748 patients were being treated with OACs by the year end 2018 — an increase of 30,319 over five years.

Warfarin prescribing, meanwhile, had fallen from 32,751 patients in 2014 to 16,166 by the year-end 2018.

Apixaban was the most frequently prescribed OAC. The research team also noted that patients treated with DOACs were older than participants in the pivotal clinical trials and were frequently co-administered interacting drugs.

Noting that the average annual cost per patient being treated with DOACs was approximately €900 as compared with €160 for warfarin (excluding monitoring costs), they said that DOACs expenditure increased from €1,023,067 per month at the start of 2014 to €4,582,874 by year-end 2018.

“At current growth rates the DOACs are set to become one of the most expensive therapies reimbursed under the community drugs schemes,” they wrote.

“Whether this increased expenditure is reflected in much improved health outcomes remains to be seen.”

IMJ; Vol 113; No. 5; P71