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Evolving Trends in Consumption of Direct Oral Anticoagulants in 65 Countries/Regions from 2008 to 2019

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Abstract

Background

Direct oral anticoagulants (DOACs) have been increasingly utilised over warfarin. However, little is known about the relative consumption trends and costs of each DOAC at the global level.

Methods

An ecological study using pharmaceutical sales data from IQVIA-MIDAS database was used to estimate consumption and cost of individual DOACs in 65 countries from 2008 to 2019. Consumption was estimated from the volume of DOACs sold, expressed as defined-daily-dose/1000-inhabitants/day (DDDTID). Compound and absolute annual growth rates were reported to quantify consumption changes over time. Costs were estimated as manufacturer price per day-of-therapy.

Results

Global consumption of dabigatran, rivaroxaban, apixaban and edoxaban were 0.31, 1.05, 1.08 and 0.78 DDDTID, respectively, in Q2–2019, compared to 0.23, 0.54, 0.21 and 0.03 in Q2–2015, with highest consumption in Western Europe, Northern Europe and Oceania (18.2, 14.07, 13.14 DDDTID). In most countries (46/65, 70%), rivaroxaban contributed to most DOAC consumption (35%–100%), whereas dabigatran accounted for less than one-third. Edoxaban accounted for < 20% of the total in Northern America and Europe but contributed significant proportions in Japan (28.58%) and South Korea (31.37%). Longer median time-to-adoption from FDA approval for apixaban and edoxaban was observed. Costs of all DOACs were ~2–4 times higher in the USA, Puerto Rico and Thailand than in other countries.

Conclusions

Regional differences exist in consumption pattern and trends of individual DOACs over the past decade. Consumption of rivaroxaban and apixaban overtook dabigatran in most countries, whereas use of edoxaban remains limited except in East Asian countries. The USA pays higher prices for DOACs than other countries.

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Acknowledgements

We thank Salman Rizvi and Ashwin Oberoi from IQVIA for their assistance and information regarding the use of IQVIA-MIDAS data.

Author information

Authors and Affiliations

  1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, General Office L02-56, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China

    Vincent K. C. Yan, Hang-Long Li, Ian C. K. Wong & Esther W. Chan

  2. Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

    Hang-Long Li

  3. Division of Cardiology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China

    Hang-Long Li

  4. Research Department of Practice and Policy, UCL School of Pharmacy, London, UK

    Li Wei & Ian C. K. Wong

  5. Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK

    Martin R. J. Knapp

  6. Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK

    Ian C. K. Wong

  7. Laboratory of Data Discovery for Health, Hong Kong SAR, China

    Li Wei, Ian C. K. Wong & Esther W. Chan

  8. Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

    Esther W. Chan

  9. The University of Hong Kong Shenzhen Institute of Research and Innovation, Hong Kong SAR, China

    Esther W. Chan

Authors
  1. Vincent K. C. Yan
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  2. Hang-Long Li
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  3. Li Wei
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Corresponding author

Correspondence to Esther W. Chan.

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Funding

This study was supported through internal seed funding from the Li Ka Shing Faculty of Medicine, The University of Hong Kong.

Conflict of interest

ICKW reports personal fees and non-financial support from IQVIA, outside the submitted work. EWC has received honorarium from the Hospital Authority, research grants from Narcotics Division of the Security Bureau of HKSAR, National Health and Medical Research Council (NHMRC, Australia), National Natural Science Foundation of China (NSFC), Research Fund Secretariat of the Food and Health Bureau (HMRF, HKSAR), Research Grants Council (RGC, HKSAR), Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Janssen, Novartis, Pfizer, RGA and Takeda outside the submitted work. All other authors declare no competing interests.

Ethics approval

This study was exempt from ethics approval by the Institutional Review Board of The University of Hong Kong and the Hong Kong West Cluster of the Hospital Authority.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Data availability

Source data was obtained under license from IQVIA: IQVIA-MIDAS monthly sales data, 2008–2018; all rights reserved. The aggregated datasets generated and analysed during the current study will be available from the corresponding author upon request.

Code availability

Not applicable.

Authors’ contributions

EWC, ICKW, and VKCY conceptualised the study. EWC and IWCK provided resources, supervised the study, and acquired the data. VKCY conducted the formal analysis and wrote the original draft. All authors read and approved the final manuscript.

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Yan, V.K.C., Li, HL., Wei, L. et al. Evolving Trends in Consumption of Direct Oral Anticoagulants in 65 Countries/Regions from 2008 to 2019. Drugs 83, 315–340 (2023). https://doi.org/10.1007/s40265-023-01837-0

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