Reimbursement and use of oral anticoagulants during 2014–2022 - A register-based study
Background: Vitamin K antagonists, warfarin in particular, have been the mainstay of anticoagulation therapy, but their use has declined in many countries since direct oral anticoagulants (DOACs) have entered the market. Objective: To examine utilization trends of oral anticoagulants (OACs) in Finla...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Exploratory Research in Clinical and Social Pharmacy |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667276623000653 |
| _version_ | 1797660072162099200 |
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| author | Emma Aarnio Risto Huupponen Janne Martikainen Maarit J. Korhonen |
| author_facet | Emma Aarnio Risto Huupponen Janne Martikainen Maarit J. Korhonen |
| author_sort | Emma Aarnio |
| collection | DOAJ |
| description | Background: Vitamin K antagonists, warfarin in particular, have been the mainstay of anticoagulation therapy, but their use has declined in many countries since direct oral anticoagulants (DOACs) have entered the market. Objective: To examine utilization trends of oral anticoagulants (OACs) in Finland considering the reimbursement of DOACs and changes to national treatment guidelines for the treatment of atrial fibrillation (AF). Methods: Both public, aggregated data on reimbursed OAC dispensations and individual-level data on electronic dispensations during 2014–2022 were applied. Data on electronic dispensations during 2015–2016 were used to study OAC initiations. Data on entitlements to reimbursement for DOACs came from public data. Results: In 2014, there were almost 20,000 DOAC users, rising to 214,000 in 2022. The number of warfarin users declined since 2015 from over 181,000 to around 59,000 users in 2022, DOACs exceeding warfarin in the number of users in 2019. The total DOAC costs were higher than warfarin costs each year. Rivaroxaban was the most widely used DOAC during 2014–2018, and apixaban during 2019–2022. In 2015, there were more warfarin (56.7%) than DOAC (43.3%) initiators, but the result was opposite for 2016 (warfarin 39.4%, DOACs 60.6%). The number of individuals entitled to reimbursement for DOACs has increased steadily, and in 2022, there were over 196,000 individuals entitled to this reimbursement due to AF. Conclusions: The uptake of DOACs in Finland appears to have been gradual and slower than in many other countries. During the 2010s, the treatment guidelines for AF were more cautious in recommending DOACs than the European guidelines. The use of DOACs increased as their reimbursement became less restrictive. |
| first_indexed | 2024-03-11T18:25:31Z |
| format | Article |
| id | doaj.art-dda08cc811e5491ab30168b43ddf849d |
| institution | Directory Open Access Journal |
| issn | 2667-2766 |
| language | English |
| last_indexed | 2024-03-11T18:25:31Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Exploratory Research in Clinical and Social Pharmacy |
| spelling | doaj.art-dda08cc811e5491ab30168b43ddf849d2023-10-14T04:45:42ZengElsevierExploratory Research in Clinical and Social Pharmacy2667-27662023-09-0111100284Reimbursement and use of oral anticoagulants during 2014–2022 - A register-based studyEmma Aarnio0Risto Huupponen1Janne Martikainen2Maarit J. Korhonen3School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; Institute of Biomedicine, University of Turku, FI-20014 University of Turku, Finland; Corresponding author at: University of Eastern Finland, School of Pharmacy, P.O. Box 1627, 70211 Kuopio, Finland.Institute of Biomedicine, University of Turku, FI-20014 University of Turku, FinlandSchool of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, FinlandInstitute of Biomedicine, University of Turku, FI-20014 University of Turku, FinlandBackground: Vitamin K antagonists, warfarin in particular, have been the mainstay of anticoagulation therapy, but their use has declined in many countries since direct oral anticoagulants (DOACs) have entered the market. Objective: To examine utilization trends of oral anticoagulants (OACs) in Finland considering the reimbursement of DOACs and changes to national treatment guidelines for the treatment of atrial fibrillation (AF). Methods: Both public, aggregated data on reimbursed OAC dispensations and individual-level data on electronic dispensations during 2014–2022 were applied. Data on electronic dispensations during 2015–2016 were used to study OAC initiations. Data on entitlements to reimbursement for DOACs came from public data. Results: In 2014, there were almost 20,000 DOAC users, rising to 214,000 in 2022. The number of warfarin users declined since 2015 from over 181,000 to around 59,000 users in 2022, DOACs exceeding warfarin in the number of users in 2019. The total DOAC costs were higher than warfarin costs each year. Rivaroxaban was the most widely used DOAC during 2014–2018, and apixaban during 2019–2022. In 2015, there were more warfarin (56.7%) than DOAC (43.3%) initiators, but the result was opposite for 2016 (warfarin 39.4%, DOACs 60.6%). The number of individuals entitled to reimbursement for DOACs has increased steadily, and in 2022, there were over 196,000 individuals entitled to this reimbursement due to AF. Conclusions: The uptake of DOACs in Finland appears to have been gradual and slower than in many other countries. During the 2010s, the treatment guidelines for AF were more cautious in recommending DOACs than the European guidelines. The use of DOACs increased as their reimbursement became less restrictive.http://www.sciencedirect.com/science/article/pii/S2667276623000653Oral anticoagulantRegisterReimbursementTreatment guidelineAtrial fibrillation |
| spellingShingle | Emma Aarnio Risto Huupponen Janne Martikainen Maarit J. Korhonen Reimbursement and use of oral anticoagulants during 2014–2022 - A register-based study Exploratory Research in Clinical and Social Pharmacy Oral anticoagulant Register Reimbursement Treatment guideline Atrial fibrillation |
| title | Reimbursement and use of oral anticoagulants during 2014–2022 - A register-based study |
| title_full | Reimbursement and use of oral anticoagulants during 2014–2022 - A register-based study |
| title_fullStr | Reimbursement and use of oral anticoagulants during 2014–2022 - A register-based study |
| title_full_unstemmed | Reimbursement and use of oral anticoagulants during 2014–2022 - A register-based study |
| title_short | Reimbursement and use of oral anticoagulants during 2014–2022 - A register-based study |
| title_sort | reimbursement and use of oral anticoagulants during 2014 2022 a register based study |
| topic | Oral anticoagulant Register Reimbursement Treatment guideline Atrial fibrillation |
| url | http://www.sciencedirect.com/science/article/pii/S2667276623000653 |
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