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Trends in Oral Anticoagulant Use and Individual Expenditures Across the United States from 2014 to 2020

  • Original Research Article
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Abstract

Background

Landmark clinical trials have expended the indications for the direct oral anticoagulants (DOACs), but contemporary data on usage and expenditure patterns are lacking.

Objective

This study aimed to assess annual trends in oral anticoagulant (OAC) utilization and expenditure across the United States (US) from 2014 to 2020.

Methods

We utilized the Medical Expenditure Panel Survey (MEPS) to study the trends of use and expenditures of warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban between 2014 and 2020 in the US. Survey respondents reported OAC use within the past year, which was verified against pharmacy records. Payment information was obtained from the respondent’s pharmacy and was categorized as third-party or self/out-of-pocket. Potential indications and medical conditions of interest for OAC therapy were identified from respondent-reported medical conditions. We estimated the national number of OAC users and total expenditures across age, sex, race, ethnicity, insurance, and medical condition subgroups. Trends of OAC users’ characteristics, expenditure, and number of prescriptions were evaluated using the Mann–Kendall test for trends.

Results

Between 2014 and 2020, the number of warfarin users decreased from 3.8 million (70% of all OAC users) to 2.2 million (p = 0.007) [29% of all OAC users], while the number of DOAC users increased from 1.6 million (30% of all OAC users) to 5.4 million (p = 0.003) [70% of all OAC users]. The total expenditure of OACs in the US increased from $3.4 billion in 2014 to $17.8 billion in 2020 (p = 0.003), which was driven by the increase in DOAC expenditures (p = 0.003).

Conclusions

DOACs have replaced warfarin as the preferred OAC in the US. The increased costs associated with DOAC use may decline when generic formulations are approved.

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Authors and Affiliations

  1. Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia

    Omar S. Alkhezi

  2. Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, MA, USA

    Omar S. Alkhezi, Leo F. Buckley & John Fanikos

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Correspondence to Omar S. Alkhezi.

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The authors did not receive support from any organizations for the submitted work.

Conflicts of interest

Omar S. Alkhezi, Leo F. Buckley, and John Fanikos have no conflicts of interest to declare relevant to the contents of this article.

Availability of data and material

Data used in this study can be found at https://meps.ahrq.gov/mepsweb/

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Authors’ contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Omar S. Alkhezi, Leo F. Buckley and John Fanikos. The first draft of the manuscript was written by Omar S. Alkhezi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Alkhezi, O.S., Buckley, L.F. & Fanikos, J. Trends in Oral Anticoagulant Use and Individual Expenditures Across the United States from 2014 to 2020. Am J Cardiovasc Drugs (2024). https://doi.org/10.1007/s40256-024-00638-4

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