Real-World Comparative Effectiveness, Safety, and Health Care Costs of Oral Anticoagulants in Nonvalvular Atrial Fibrillation Patients in the U.S. Department of Defense Population

Journal of Managed Care & Specialty Pharmacy
Kiran GuptaTom Shank

Abstract

The ARISTOTLE trial demonstrated that apixaban had significantly lower rates of stroke/systemic embolism (SE) and major bleeding than warfarin; however, no direct clinical trials between apixaban and other direct oral anticoagulants (DOACs) are available. Few real-world studies comparing the effectiveness and safety between DOACs have been conducted. To compare effectiveness, safety, and health care costs among oral anticoagulants (OACs) for nonvalvular atrial fibrillation (NVAF) patients in the U.S. Department of Defense (DoD) population. Adult NVAF patients initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from U.S. DoD data from January 1, 2013, to September 30, 2015. The first OAC claim date was designated as the index date. Patients initiating another OAC were matched 1:1 to apixaban patients using propensity score matching to balance demographics and clinical characteristics. Cox proportional hazards models were used to estimate the risk of stroke/SE and major bleeding for each OAC versus apixaban. Generalized linear and two-part models with bootstrapping were used to compare all-cause health care costs and stroke/SE-related and major bleeding-related medical costs. Of the 41,001 eligible ...Continue Reading

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Citations

Apr 9, 2020·Clinical and Translational Science·Robyn KonickiJ Robert Powell
Jun 9, 2019·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Antonios DourosKristian B Filion
Sep 1, 2020·Journal of the American Heart Association·Mengyuan ShiAlvaro Alonso
Sep 9, 2020·Journal of Medical Economics·Dejan MilentijevicPatrick Lefebvre
Nov 27, 2020·British Journal of Clinical Pharmacology·Madeleine DurandUNKNOWN Canadian Network for Observational Drug Effect Studies (CNODES) Investigators
Sep 1, 2021·Journal of Clinical Pharmacy and Therapeutics·Zhiyan LiuYimin Cui

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