National Trends in Oral Anticoagulant Use in the United States, 2007 to 2011
Little is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of thromboembolism in the United States. We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of office-...
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| Published in | Circulation Cardiovascular quality and outcomes Vol. 5; no. 5; pp. 615 - 621 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hagerstown, MD
Lippincott Williams & Wilkins
01.09.2012
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Little is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of thromboembolism in the United States.
We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of office-based providers, to quantify patterns of oral anticoagulant use among all subjects and stratified by clinical indication. We quantified oral anticoagulant expenditures using the IMS Health National Prescription Audit. Between 2007 and 2011, warfarin treatment visits declined from ≈2.1 million (M) quarterly visits to ≈1.6M visits. Dabigatran use increased from 0.062M quarterly visits (2010Q4) to 0.363M visits (2011Q4), reflecting its increasing share of oral anticoagulant visits from 3.1% to 18.9%. In contrast to warfarin, the majority of dabigatran visits have been for atrial fibrillation, though this proportion decreased from 92% (2010Q4) to 63% (2011Q4), with concomitant increases in dabigatran's off-label use. Among atrial fibrillation visits, warfarin use decreased from 55.8% visits (2010Q4) to 44.4% (2011Q4), whereas dabigatran use increased from 4.0% to 16.9%. Of atrial fibrillation visits, the fraction not treated with any oral anticoagulants has remained unchanged at ≈40%. Expenditures related to dabigatran increased rapidly from $16M in 2010Q4 to $166M in 2011Q4, exceeding expenditures on warfarin ($144M) in 2011Q4.
Dabigatran has been rapidly adopted into ambulatory practice in the United States, primarily for treatment of atrial fibrillation, but increasingly for off-label indications. We did not find evidence that it has increased overall atrial fibrillation treatment rates. |
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| AbstractList | Little is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of thromboembolism in the United States.
We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of office-based providers, to quantify patterns of oral anticoagulant use among all subjects and stratified by clinical indication. We quantified oral anticoagulant expenditures using the IMS Health National Prescription Audit. Between 2007 and 2011, warfarin treatment visits declined from ≈2.1 million (M) quarterly visits to ≈1.6M visits. Dabigatran use increased from 0.062M quarterly visits (2010Q4) to 0.363M visits (2011Q4), reflecting its increasing share of oral anticoagulant visits from 3.1% to 18.9%. In contrast to warfarin, the majority of dabigatran visits have been for atrial fibrillation, though this proportion decreased from 92% (2010Q4) to 63% (2011Q4), with concomitant increases in dabigatran's off-label use. Among atrial fibrillation visits, warfarin use decreased from 55.8% visits (2010Q4) to 44.4% (2011Q4), whereas dabigatran use increased from 4.0% to 16.9%. Of atrial fibrillation visits, the fraction not treated with any oral anticoagulants has remained unchanged at ≈40%. Expenditures related to dabigatran increased rapidly from $16M in 2010Q4 to $166M in 2011Q4, exceeding expenditures on warfarin ($144M) in 2011Q4.
Dabigatran has been rapidly adopted into ambulatory practice in the United States, primarily for treatment of atrial fibrillation, but increasingly for off-label indications. We did not find evidence that it has increased overall atrial fibrillation treatment rates. Little is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of thromboembolism in the United States.BACKGROUNDLittle is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of thromboembolism in the United States.We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of office-based providers, to quantify patterns of oral anticoagulant use among all subjects and stratified by clinical indication. We quantified oral anticoagulant expenditures using the IMS Health National Prescription Audit. Between 2007 and 2011, warfarin treatment visits declined from ≈2.1 million (M) quarterly visits to ≈1.6M visits. Dabigatran use increased from 0.062M quarterly visits (2010Q4) to 0.363M visits (2011Q4), reflecting its increasing share of oral anticoagulant visits from 3.1% to 18.9%. In contrast to warfarin, the majority of dabigatran visits have been for atrial fibrillation, though this proportion decreased from 92% (2010Q4) to 63% (2011Q4), with concomitant increases in dabigatran's off-label use. Among atrial fibrillation visits, warfarin use decreased from 55.8% visits (2010Q4) to 44.4% (2011Q4), whereas dabigatran use increased from 4.0% to 16.9%. Of atrial fibrillation visits, the fraction not treated with any oral anticoagulants has remained unchanged at ≈40%. Expenditures related to dabigatran increased rapidly from $16M in 2010Q4 to $166M in 2011Q4, exceeding expenditures on warfarin ($144M) in 2011Q4.METHODS AND RESULTSWe used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of office-based providers, to quantify patterns of oral anticoagulant use among all subjects and stratified by clinical indication. We quantified oral anticoagulant expenditures using the IMS Health National Prescription Audit. Between 2007 and 2011, warfarin treatment visits declined from ≈2.1 million (M) quarterly visits to ≈1.6M visits. Dabigatran use increased from 0.062M quarterly visits (2010Q4) to 0.363M visits (2011Q4), reflecting its increasing share of oral anticoagulant visits from 3.1% to 18.9%. In contrast to warfarin, the majority of dabigatran visits have been for atrial fibrillation, though this proportion decreased from 92% (2010Q4) to 63% (2011Q4), with concomitant increases in dabigatran's off-label use. Among atrial fibrillation visits, warfarin use decreased from 55.8% visits (2010Q4) to 44.4% (2011Q4), whereas dabigatran use increased from 4.0% to 16.9%. Of atrial fibrillation visits, the fraction not treated with any oral anticoagulants has remained unchanged at ≈40%. Expenditures related to dabigatran increased rapidly from $16M in 2010Q4 to $166M in 2011Q4, exceeding expenditures on warfarin ($144M) in 2011Q4.Dabigatran has been rapidly adopted into ambulatory practice in the United States, primarily for treatment of atrial fibrillation, but increasingly for off-label indications. We did not find evidence that it has increased overall atrial fibrillation treatment rates.CONCLUSIONSDabigatran has been rapidly adopted into ambulatory practice in the United States, primarily for treatment of atrial fibrillation, but increasingly for off-label indications. We did not find evidence that it has increased overall atrial fibrillation treatment rates. |
| Author | Alexander, G. Caleb Stafford, Randall S. Qato, Dima M. Kirley, Kate Kornfield, Rachel |
| AuthorAffiliation | 1 Department of Family Medicine, University of Chicago, Chicago, Illinois 6 Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Illinois 2 Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois 4 MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois 3 Stanford University, Program on Prevention Outcomes and Practices, Palo Alto, California 5 Center for Health and Social Sciences, University of Chicago, Chicago, Illinois |
| AuthorAffiliation_xml | – name: 2 Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois – name: 6 Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Illinois – name: 4 MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois – name: 5 Center for Health and Social Sciences, University of Chicago, Chicago, Illinois – name: 3 Stanford University, Program on Prevention Outcomes and Practices, Palo Alto, California – name: 1 Department of Family Medicine, University of Chicago, Chicago, Illinois |
| Author_xml | – sequence: 1 givenname: Kate surname: Kirley fullname: Kirley, Kate organization: From the Department of Family Medicine, University of Chicago, Chicago, IL (K.K.); Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL (D.M.Q., R.K., G.C.A.); Stanford University, Program on Prevention Outcomes and Practices, Palo Alto, CA (R.S.S.); MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL (G.C.A.); Center for Health and Social Sciences, University of Chicago, Chicago, IL (G.C.A.); and Department of Pharmacy Practice – sequence: 2 givenname: Dima M. surname: Qato fullname: Qato, Dima M. organization: From the Department of Family Medicine, University of Chicago, Chicago, IL (K.K.); Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL (D.M.Q., R.K., G.C.A.); Stanford University, Program on Prevention Outcomes and Practices, Palo Alto, CA (R.S.S.); MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL (G.C.A.); Center for Health and Social Sciences, University of Chicago, Chicago, IL (G.C.A.); and Department of Pharmacy Practice – sequence: 3 givenname: Rachel surname: Kornfield fullname: Kornfield, Rachel organization: From the Department of Family Medicine, University of Chicago, Chicago, IL (K.K.); Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL (D.M.Q., R.K., G.C.A.); Stanford University, Program on Prevention Outcomes and Practices, Palo Alto, CA (R.S.S.); MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL (G.C.A.); Center for Health and Social Sciences, University of Chicago, Chicago, IL (G.C.A.); and Department of Pharmacy Practice – sequence: 4 givenname: Randall S. surname: Stafford fullname: Stafford, Randall S. organization: From the Department of Family Medicine, University of Chicago, Chicago, IL (K.K.); Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL (D.M.Q., R.K., G.C.A.); Stanford University, Program on Prevention Outcomes and Practices, Palo Alto, CA (R.S.S.); MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL (G.C.A.); Center for Health and Social Sciences, University of Chicago, Chicago, IL (G.C.A.); and Department of Pharmacy Practice – sequence: 5 givenname: G. Caleb surname: Alexander fullname: Alexander, G. Caleb organization: From the Department of Family Medicine, University of Chicago, Chicago, IL (K.K.); Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL (D.M.Q., R.K., G.C.A.); Stanford University, Program on Prevention Outcomes and Practices, Palo Alto, CA (R.S.S.); MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL (G.C.A.); Center for Health and Social Sciences, University of Chicago, Chicago, IL (G.C.A.); and Department of Pharmacy Practice |
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| Copyright | 2015 INIST-CNRS |
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| Keywords | Chemotherapy Treatment Use coumarins Trend anticoagulants Anticoagulant Coumarin other anticoagulants |
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| Snippet | Little is known regarding the adoption of direct thrombin inhibitors in clinical practice. We examine trends in oral anticoagulation for the prevention of... |
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| SubjectTerms | Administration, Oral Aged Aged, 80 and over Ambulatory Care - trends Anticoagulants - administration & dosage Anticoagulants - economics Antithrombins - administration & dosage Antithrombins - economics Atrial Fibrillation - drug therapy Atrial Fibrillation - economics Atrial Fibrillation - epidemiology Benzimidazoles - administration & dosage beta-Alanine - administration & dosage beta-Alanine - analogs & derivatives Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Dabigatran Drug Costs Drug Prescriptions - statistics & numerical data Drug Utilization - trends Drug Utilization Review Guideline Adherence - trends Health Care Surveys Health Expenditures Humans Medical Audit Medical sciences Middle Aged Off-Label Use - statistics & numerical data Pharmacology. Drug treatments Practice Guidelines as Topic Practice Patterns, Physicians' - economics Practice Patterns, Physicians' - trends Preventive Health Services - economics Preventive Health Services - trends Thromboembolism - economics Thromboembolism - epidemiology Thromboembolism - prevention & control Time Factors United States - epidemiology Warfarin - administration & dosage |
| Title | National Trends in Oral Anticoagulant Use in the United States, 2007 to 2011 |
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