新型口服抗凝药物上市后，澳大利亚的抗凝药物使用量和支出迅速大幅增加。
Rapid and substantial increases in anticoagulant use and expenditure in Australia following the introduction of new types of oral anticoagulants.
机构信息
National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
出版信息
PLoS One. 2018 Dec 6;13(12):e0208824. doi: 10.1371/journal.pone.0208824. eCollection 2018.
OBJECTIVES
To quantify changes in anticoagulant use in Australia since the introduction of Non-vitamin K antagonist anticoagulants (NOACs) and to estimate government expenditure.
DESIGN
Interrupted-time-series analysis quantifying anticoagulant dispensing, before and after first Pharmaceutical Benefits Scheme (PBS) NOAC listing in August 2009 for venous thromboembolism prevention; and expanded listing for stroke prevention in non-valvular atrial fibrillation (AF) in August 2013, up to June 2016. Estimated government expenditure on PBS-listed anticoagulants.
SETTING AND PARTICIPANTS
PBS dispensing in 10% random sample of Australians, restricted to continuous concessional beneficiaries dispensed oral anticoagulants from July 2005 to June 2016. Total PBS anticoagulant expenditure was calculated using Medicare Australia statistics.
MAIN OUTCOME MEASURES
Monthly dispensing and initiation of oral anticoagulants (warfarin, rivaroxaban, dabigatran or apixaban). Annual PBS anticoagulant expenditure.
RESULTS
An estimated 149,180 concessional beneficiaries were dispensed anticoagulants (100% warfarin) during July 2005. This increased to 292,550 during June 2016, of whom 47.0%, 27.1%, 18.7% and 7.2% were dispensed warfarin, rivaroxaban, apixaban and dabigatran, respectively. Of 16,500 initiated on anticoagulants in June 2016, 24.3%, 38.2%, 30.0% and 7.5% were initiated on warfarin, rivaroxaban, apixaban, and dabigatran, respectively. Compared to July 2005-July 2013, from August 2013-June 2016, dispensings for all anticoagulants increased by 2,303 dispensings/month (p<0.001, 95%CI = [1,229 3,376]); warfarin dispensing decreased by 1,803 dispensings/month (p<0.001, 95%CI = [-2,606, -1,000]). Total PBS anticoagulant expenditure was $19.5 million (97.0% concessional) in 2008/09, of which 100% was warfarin and $203.3 million (86.2% concessional) in 2015/16, of which 11.2% was warfarin.
CONCLUSIONS
The introduction of the NOACs led to substantial increases in anticoagulant use and expenditure in Australia.
目的
量化自非维生素 K 拮抗剂抗凝剂（NOACs）引入以来澳大利亚抗凝剂使用的变化，并估算政府支出。
设计
在 2009 年 8 月首次列入药品福利计划（PBS）用于预防静脉血栓栓塞症和 2013 年 8 月扩大用于非瓣膜性心房颤动（AF）卒中预防的 NOAC 之后，进行静脉血栓栓塞症预防的时间序列分析，量化抗凝剂的配药情况，直到 2016 年 6 月。估计 PBS 上市的抗凝剂的政府支出。
地点和参与者
2005 年 7 月至 2016 年 6 月，澳大利亚 10%的随机抽样人群中的 PBS 配药情况，仅限于连续享受优惠的受益人配服口服抗凝剂。使用澳大利亚医疗保险统计数据计算 PBS 抗凝剂的总支出。
主要观察指标
每月配服和开始使用口服抗凝剂（华法林、利伐沙班、达比加群或阿哌沙班）。PBS 抗凝剂的年度政府支出。
结果
2005 年 7 月，约有 149180 名优惠受益人配服了抗凝剂（100%华法林）。到 2016 年 6 月，这一数字增加到 292550 人，其中 47.0%、27.1%、18.7%和 7.2%分别配服了华法林、利伐沙班、阿哌沙班和达比加群。在 2016 年 6 月开始服用抗凝剂的 16500 人中，分别有 24.3%、38.2%、30.0%和 7.5%开始服用华法林、利伐沙班、阿哌沙班和达比加群。与 2005 年 7 月至 2013 年 7 月相比，自 2013 年 8 月至 2016 年 6 月，所有抗凝剂的配药量每月增加 2303 次（p<0.001，95%CI = [1229 3376]）；华法林的配药量每月减少 1803 次（p<0.001，95%CI = [-2606 -1000]）。2008/09 年 PBS 抗凝剂支出为 1.95 亿美元（97.0%为优惠），其中 100%为华法林；2015/16 年支出为 2.033 亿美元（86.2%为优惠），其中 11.2%为华法林。
结论
NOACs 的引入导致澳大利亚抗凝剂的使用和支出大幅增加。
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