Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Health Outcomes Division, The University of Texas at Austin College of Pharmacy, Austin, Texas.
Am J Prev Med. 2024 Mar;66(3):463-472. doi: 10.1016/j.amepre.2023.10.014. Epub 2023 Oct 21.
This study documents cost trends in oral anticoagulants (OAC) in patients with newly diagnosed atrial fibrillation.
Using MarketScan databases, the mean annual patients' out-of-pocket costs, insurance payments, and the proportion of patients initiating OAC within 90 days from atrial fibrillation diagnosis were calculated from July 2014 to June 2021. Costs of OACs (apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin) and the payments by three insurance types (commercial payers, Medicare, and Medicaid) were calculated. Patients' out-of-pocket costs and insurance payments were adjusted to 2021 prices. Joinpoint regression models were used to test trends of outcomes and average annual percent changes (AAPC) were reported. Data analyses were performed in 2022-2023.
From July 2014 to June 2021, the mean annual out-of-pocket costs of any OAC increased for commercial insurance (AAPC 3.0%) and Medicare (AAPC 5.1%) but decreased for Medicaid (AAPC -3.3%). The mean annual insurance payments for any OAC significantly increased for all insurance groups (AAPC 13.1% [95% CI 11.3-15.0] for Medicare; AAPC 11.8% [95% CI 8.0-15.6] for commercial insurance; and AAPC 16.3% [95% CI 11.3-21.4] for Medicaid). The initiation of any OAC increased (AAPC 7.3% for commercial insurance; AAPC 10.2% for Medicare; AAPC 5.3% for Medicaid).
There was a substantial increase in the overall cost burden of OACs and OAC initiation rates in patients with newly diagnosed atrial fibrillation in 2014-2021; these findings provide insights into the current and anticipated impact of rising drug prices on patients' and payers' financial burden.
本研究记录了新诊断为心房颤动患者的口服抗凝药物（OAC）的成本趋势。
使用 MarketScan 数据库，从 2014 年 7 月至 2021 年 6 月，计算出新诊断为心房颤动的患者每年的自付费用、保险支付额以及 90 天内开始使用 OAC 的患者比例。计算了 OAC（阿哌沙班、达比加群、依度沙班、利伐沙班和华法林）的费用以及三种保险类型（商业支付者、医疗保险和医疗补助）的支付额。将患者的自付费用和保险支付额调整为 2021 年的价格。使用 Joinpoint 回归模型检验结果趋势，报告平均年百分比变化（AAPC）。数据分析于 2022-2023 年进行。
从 2014 年 7 月至 2021 年 6 月，商业保险（AAPC3.0%）和医疗保险（AAPC5.1%）的任何 OAC 的年平均自付费用增加，但医疗补助（AAPC-3.3%）的自付费用减少。所有保险组别的任何 OAC 的年平均保险支付额均显著增加（医疗保险为 13.1%[95%CI11.3-15.0]；商业保险为 11.8%[95%CI8.0-15.6]；医疗补助为 16.3%[95%CI11.3-21.4]）。任何 OAC 的使用开始增加（商业保险为 7.3%；医疗保险为 10.2%；医疗补助为 5.3%）。
在 2014 年至 2021 年期间，新诊断为心房颤动的患者的 OAC 整体费用负担和 OAC 起始率大幅增加；这些发现提供了关于药物价格上涨对患者和支付者经济负担的当前和预期影响的见解。
