Novel oral anticoagulants for non-atrial fibrillation indications: utilisation analysis
Page last updated: 6 March 2015
Drug utilisation sub-committee (DUSC)
October 2014
Abstract
Purpose
To the examine utilisation of medicines referred to as the novel oral anticoagulants (NOACs), rivaroxaban, apixaban and dabigatran for the treatment of deep vein thrombosis (DVT), the prevention of venous thromboembolism (VTE), treatment of pulmonary embolism (PE) and for the prevention of recurrent venous thromboembolism.
To compare the predicted versus actual utilisation of rivaroxaban for acute symptomatic DVT and PE.
Data Source / methodology
Data for the number of prescriptions for rivaroxaban, dabigatran and apixaban were extracted from the Department of Human Services (DHS) Medicare Pharmacy Claims database for the period August 2009 to March 2014, inclusive. The number of patients treated for DVT and PE was determined by counting the number of individual de-identified personal identification numbers in the specified time period. The use of rivaroxaban for DVT and PE is compared to the use predicted in the submission.
Key Findings
- The DUSC considered that the use of NOACs for the prevention of VTE in hip and knee replacements has remained quite low and stable since it was reviewed in June 2011, as expected for a short term treatment for a limited patient group.
- The DUSC considered that the use of rivaroxaban for treatment of DVT and PE, and prevention of recurrent VTE is steadily increasing.
- In the most recent 12 months of data (April 2013 to March 2014) there were 1,587 prescriptions dispensed for apixaban, 2,279 for dabigatran and 115,179 for rivaroxaban. These values exclude use for the prevention of stroke or systemic embolism in patients with non-valvular atrial fibrillation (AF).
- Of the 115,179 prescriptions dispensed for rivaroxaban, 70 % of these were for treatment of DVT or prevention of recurrent VTE.
- In its first year of listing for DVT, 12,646 patients were supplied rivaroxaban for DVT treatment or prevention of recurrent VTE.
- Rivaroxaban was listed for pulmonary embolism for eight months of the 12 month period April 2013 to March 2014. Of the 115,179 prescriptions dispensed for rivaroxaban, 11 % of these were for pulmonary embolism.
- As predicted in the March 2012 DUSC advice, the number of patients, prescriptions and cost were underestimated in the rivaroxaban submission for confirmed acute symptomatic DVT without symptomatic PE, and for the prevention of recurrent venous thromboembolism. In year 1, the number of patients supplied with rivaroxaban for DVT and prevention of recurrent VTEs (including item codes 2160Q and 2268J) was 7.01 times higher than predicted, the number of prescriptions 4.07 times higher than predicted, and the benefits paid 8.42 times higher than predicted.
