TY - JOUR
T1 - Modeling the impact of real-world adherence to once-daily (QD) versus twice-daily (BID) non-vitamin K antagonist oral anticoagulants on stroke and major bleeding events among non-valvular atrial fibrillation patients
AU - McHorney, Colleen A.
AU - Peterson, Eric D.
AU - Ashton, Veronica
AU - Laliberté, François
AU - Crivera, Concetta
AU - Germain, Guillaume
AU - Sheikh, Naveed
AU - Schein, Jeff
AU - Lefebvre, Patrick
N1 - Funding Information:
This manuscript was funded by Janssen Scientific Affairs.
Funding Information:
V.A. and C.C. are employees of Janssen Scientific Affairs, LLC. J.S. was an employee of Janssen Scientific Affairs, LLC at the time of the study. F.L., G.G., N.S., and P.L. are employees of Groupe d’analyse, Ltée, a consulting company that has received research grants from Janssen Scientific Affairs, LLC. C.A.M. is an employee of Evidera, a consulting company that has received research grants from Janssen Scientific Affairs, LLC. E.D.P. has received research grants from Janssen Scientific Affairs, LLC. CMRO peer reviewers have no financial/other interests to disclose.
Publisher Copyright:
© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2019/4/3
Y1 - 2019/4/3
N2 - Objectives: To estimate the real-world (RW) impact of adherence to once-daily (QD: rivaroxaban and edoxaban) and twice-daily (BID: apixaban and dabigatran) non-vitamin K antagonist (NOACs) on the risk of stroke and major bleeding (MB) among non-valvular atrial fibrillation (NVAF) patients. Methods: First, claims from the Optum Clinformatics Data Mart database (July 2012–December 2016) were analyzed. Adult NVAF patients with ≥2 NOAC dispensings (index date) were included. The relationship between NOAC adherence (proportion of days covered ≥80%) and stroke/MB 1-year post-index was evaluated using adjusted Cox proportional hazards models. Second, the natural logarithm of hazard ratios (HRs) was multiplied to a literature-derived mean adherence difference between QD and BID NOACs yielding stroke and MB rates. Third, these rates were multiplied by 1-year Kaplan-Meier rates of stroke and MB which yielded the number of strokes prevented and MBs caused. Annual cost savings were evaluated using literature-based stroke ($81,414/patient) and MB ($63,905/patient) cost estimates. Results: In total, 54,280 patients were included. HRs for adherent vs non-adherent patients were 0.67 (p <.001) for stroke and 1.09 (p =.179) for MB. The claims-derived 1-year Kaplan-Meier rates were 3.0% and 3.4% for strokes and MBs, respectively. For 100,000 AF patients, 64 strokes were prevented (p <.001), and a non-significant number of MBs (n = 15, p <.191) were caused by QD vs BID NOACs annually, which leads to cost savings estimated at $58 million for QD NOACs. Conclusion: QD NOACs prevented a significant number of strokes and caused no significant increase in MBs compared to BID NOACs, which leads to significant net cost savings for NVAF patients in the US.
AB - Objectives: To estimate the real-world (RW) impact of adherence to once-daily (QD: rivaroxaban and edoxaban) and twice-daily (BID: apixaban and dabigatran) non-vitamin K antagonist (NOACs) on the risk of stroke and major bleeding (MB) among non-valvular atrial fibrillation (NVAF) patients. Methods: First, claims from the Optum Clinformatics Data Mart database (July 2012–December 2016) were analyzed. Adult NVAF patients with ≥2 NOAC dispensings (index date) were included. The relationship between NOAC adherence (proportion of days covered ≥80%) and stroke/MB 1-year post-index was evaluated using adjusted Cox proportional hazards models. Second, the natural logarithm of hazard ratios (HRs) was multiplied to a literature-derived mean adherence difference between QD and BID NOACs yielding stroke and MB rates. Third, these rates were multiplied by 1-year Kaplan-Meier rates of stroke and MB which yielded the number of strokes prevented and MBs caused. Annual cost savings were evaluated using literature-based stroke ($81,414/patient) and MB ($63,905/patient) cost estimates. Results: In total, 54,280 patients were included. HRs for adherent vs non-adherent patients were 0.67 (p <.001) for stroke and 1.09 (p =.179) for MB. The claims-derived 1-year Kaplan-Meier rates were 3.0% and 3.4% for strokes and MBs, respectively. For 100,000 AF patients, 64 strokes were prevented (p <.001), and a non-significant number of MBs (n = 15, p <.191) were caused by QD vs BID NOACs annually, which leads to cost savings estimated at $58 million for QD NOACs. Conclusion: QD NOACs prevented a significant number of strokes and caused no significant increase in MBs compared to BID NOACs, which leads to significant net cost savings for NVAF patients in the US.
KW - Anticoagulants
KW - Atrial fibrillation
KW - Bleeding
KW - Stroke
KW - Treatment adherence and compliance
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U2 - 10.1080/03007995.2018.1530205
DO - 10.1080/03007995.2018.1530205
M3 - Article
C2 - 30265159
AN - SCOPUS:85055729224
SN - 0300-7995
VL - 35
SP - 653
EP - 660
JO - Current Medical Research and Opinion
JF - Current Medical Research and Opinion
IS - 4
ER -