Zhdanava Maryia, Ashton Veronica, Korsiak Jill, Jiang Fengyi, Pilon Dominic, Alberts Mark
Analysis Group, Inc., Montreal, QC, Canada.
Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Titusville, NJ.
J Manag Care Spec Pharm. 2025 Apr;31(4):366-376. doi: 10.18553/jmcp.2025.31.4.366.
Direct oral anticoagulants (DOACs) are used to prevent thrombosis in patients with nonvalvular atrial fibrillation (NVAF) and venous thromboembolism (VTE). Despite their clinical benefits, some patients abandon their DOAC prescription.
To retrospectively evaluate the association between patient out-of-pocket (OOP) costs and abandonment of the first DOAC prescription among patients with NVAF or VTE in the United States.
Data from Symphony Health, an ICON plc Company, PatientSource (April 1, 2017, to October 31, 2020) were used to select patients with NVAF or VTE with an approved or abandoned claim for a DOAC (apixaban, dabigatran, rivaroxaban). OOP costs (2021 US dollars) of the index claim were described by abandonment status, and multivariable logistic regression models were used to evaluate the association between OOP costs of the index DOAC claim and abandonment. Analyses were performed in patients with NVAF and VTE separately.
Among 753,755 patients with NVAF, 88.5% had an approved index DOAC claim and 11.5% had an abandoned index DOAC claim. Among 308,429 patients with VTE, 91.5% had an approved index DOAC claim and 8.5% had an abandoned index DOAC claim. Mean OOP costs of the index DOAC claim were lower in those with an approved than abandoned claim (NVAF approved vs abandoned: $79 vs $175; VTE approved vs abandoned: $65 vs $133). Among patients with NVAF, 21.4% of those with an approved claim and 9.1% of those with an abandoned claim had no OOP costs, 58.7% (approved) and 49.0% (abandoned) had OOP costs greater than $0 to less than $100, and 19.9% (approved) and 41.9% (abandoned) had OOP costs greater than or equal to $100; among patients with VTE, 27.8% (approved) and 15.6% (abandoned) had no OOP costs, 58.4% (approved) and 54.8% (abandoned) had OOP costs greater than $0 to less than $100, and 13.8% (approved) and 29.6% (abandoned) had OOP costs greater than or equal to $100. In multivariable models, the risk of abandonment increased by 21% (NVAF) and 17% (VTE) for each $100 in OOP costs (both < 0.001). Relative to patients with no OOP costs, patients with OOP costs greater than $0 to less than $50 were 86% (NVAF) and 55% (VTE) more likely to abandon their index DOAC, patients with OOP costs greater than $50 to less than $100 were 80% (NVAF) and 111% (VTE) more likely to abandon their index DOAC, and patients with OOP costs greater than or equal to $100 were 332% (NVAF) and 244% (VTE) more likely to abandon their index DOAC (all < 0.001).
Among patients with NVAF or VTE, OOP costs of the first DOAC claim greater than or equal to $100 were associated with the highest risk of abandoning the first DOAC prescription.
直接口服抗凝剂（DOACs）用于预防非瓣膜性心房颤动（NVAF）和静脉血栓栓塞（VTE）患者的血栓形成。尽管它们具有临床益处，但一些患者会放弃DOAC处方。
回顾性评估美国NVAF或VTE患者的自付费用（OOP）与首次DOAC处方放弃之间的关联。
使用来自ICON plc公司Symphony Health的PatientSource数据（2017年4月1日至2020年10月31日），选择有DOAC（阿哌沙班、达比加群、利伐沙班）批准或放弃索赔的NVAF或VTE患者。首次索赔的OOP费用（2021美元）按放弃状态进行描述，并使用多变量逻辑回归模型评估首次DOAC索赔的OOP费用与放弃之间的关联。分别对NVAF和VTE患者进行分析。
在753,755例NVAF患者中，88.5%的首次DOAC索赔获得批准，11.5%的首次DOAC索赔被放弃。在308,429例VTE患者中，91.5%的首次DOAC索赔获得批准，8.5%的首次DOAC索赔被放弃。首次DOAC索赔的平均OOP费用在索赔获得批准的患者中低于索赔被放弃的患者（NVAF批准与放弃：79美元对175美元；VTE批准与放弃：65美元对133美元）。在NVAF患者中，21.4%的索赔获得批准的患者和9.1%的索赔被放弃的患者没有OOP费用，58.7%（批准）和49.0%（放弃）的患者OOP费用大于0美元至小于100美元，19.9%（批准）和41.9%（放弃）的患者OOP费用大于或等于100美元；在VTE患者中，27.8%（批准）和15.6%（放弃）的患者没有OOP费用，58.4%（批准）和54.8%（放弃）的患者OOP费用大于0美元至小于100美元，13.8%（批准）和29.6%（放弃）的患者OOP费用大于或等于100美元。在多变量模型中，OOP费用每增加100美元，放弃风险增加21%（NVAF）和17%（VTE）（均P<0.001）。相对于没有OOP费用的患者，OOP费用大于0美元至小于50美元的患者放弃首次DOAC的可能性高86%（NVAF）和55%（VTE），OOP费用大于50美元至小于100美元的患者放弃首次DOAC的可能性高80%（NVAF）和111%（VTE），OOP费用大于或等于100美元的患者放弃首次DOAC的可能性高332%（NVAF）和244%（VTE）（均P<0.001）。
在NVAF或VTE患者中，首次DOAC索赔的OOP费用大于或等于100美元与放弃首次DOAC处方的风险最高相关。
