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Prescription Patterns of Non-Vitamin K Oral Anticoagulants Across Indications and Factors Associated with Their Increased Prescribing in Atrial Fibrillation Between 2012–2015: A Study from the Norwegian Prescription Database

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Abstract

Objective

We studied prescription patterns for non-vitamin K oral anticoagulants (NOACs) in Norway between 2012 and 2015, and compared NOAC and warfarin patient characteristics such as age, gender and cardiovascular (CV) co-medications across reimbursed indications. Factors associated with NOAC prescribing in atrial fibrillation (AF) were also analysed.

Methods

All Norwegian patients (N = 156,124) who received at least one dispensed NOAC or warfarin prescription within the indications of AF, deep vein thrombosis and pulmonary embolism (DVT_PE) or prevention of venous thromboembolic events after a hip or knee surgery (VTE_surg) between 2012 and 2015 were included in the study. Descriptive statistics was applied to compare patient characteristics between NOACs and warfarin across indications and a logistic regression model was used to identify factors associated with NOAC prescribing in AF.

Results

NOACs and warfarin were most commonly prescribed in AF (83,729 patients in 2015), followed by DVT_PE (16,077 patients) and lastly in VTE_surg (4060 patients). In 2015, NOACs achieved a dominant (>50%) patient share over warfarin in AF and DVT_PE, and were prescribed in >80% of new oral anticoagulation (OAC) patients. Apixaban, despite its delayed market entry, emerged as the preferred NOAC in VTE_surg (46% share), whereas rivaroxaban captured a 43% patient share in DVT_PE. Warfarin patients were on average older and received more CV co-medication than NOAC patients in AF and DVT_PE. Age, gender and certain CV co-medications emerged as significant predictors of NOAC prescribing in AF. AF patients <70 years old had higher odds of NOAC prescribing (OR 1.19–1.29, depending on age category), in contrast to patients >74 years old (OR 0.51–0.77). Women had 32% higher odds of receiving a NOAC in AF.

Conclusion

NOACs achieved a dominant market share over warfarin within 3 years from receiving reimbursement in Norway. There were significant differences in patient characteristics between drugs and indications.

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Acknowledgements

We thank Dr Karsten Bruins Slot of the Committee for Medicinal Products for Human Use (CHMP) and NOMA for his medical feedback and Sunil Modi of the University College London for his editorial assistance.

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Authors and Affiliations

  1. HTA and Reimbursement Unit, The Norwegian Medicines Agency (NOMA), Strømsveien 96, 0663, Oslo, Norway

    Anna Maria Urbaniak, Bjørn Oddvar Strøm, Randi Krontveit & Kristin Helene Svanqvist

  2. Department of Economics, School of Arts and Social Sciences, University of London, London, UK

    Anna Maria Urbaniak

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  1. Anna Maria Urbaniak
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Correspondence to Anna Maria Urbaniak.

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No funding was used in the conduct of this study or preparation of the manuscript.

Conflict of interest

A.M. Urbaniak, B.O. Strøm, R. Krontveit and K.H. Svanqvist declare that they have no conflict of interest.

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Urbaniak, A.M., Strøm, B.O., Krontveit, R. et al. Prescription Patterns of Non-Vitamin K Oral Anticoagulants Across Indications and Factors Associated with Their Increased Prescribing in Atrial Fibrillation Between 2012–2015: A Study from the Norwegian Prescription Database. Drugs Aging 34, 635–645 (2017). https://doi.org/10.1007/s40266-017-0476-4

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