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Prescribing Trends of Oral Anticoagulants from 2010 to 2020 in Shanghai, China: A Retrospective Study
Aim:
Non-vitamin K antagonist oral anticoagulants (NOACs) were developed as an alternative to warfarin to prevent thromboembolism in patients with atrial fibrillation (AF), prosthetic heart valves, venous thromboembolism (VTE), or other thrombotic disorders. The aim of this study is to explore the trends in prescribing OACs, including warfarin and NOACs, in Shanghai, China.
Methods:
Prescription data of OACs were retrospectively collected from Rx Analysis System from 2010 to 2020 in Shanghai, China. Comparisons were made on the trends of each OACs according to different indications, age groups, and hospital grades. The costs and the contribution of individual OACs were also explored.
Results:
Growing trends in overall prescriptions for OACs were observed. The prescriptions of NOACs were significantly increased since 2016, while the prescriptions of warfarin kept decreasing since 2017. A highly statistically significant increase in prescriptions of Rivaroxaban was observed from 2016 to 2020 (P < .001). Despite the price reduction of rivaroxaban in 2018, the total cost of rivaroxaban continued to rise (P < .001). Rivaroxaban emerged as a preferred NOAC in both indications of AF and VTE, and accounted for more than three-quarters of the total costs for OACs since 2019. Compared with rivaroxaban, the prescription numbers of dabigatran and apixaban were much smaller, and the growth of prescriptions were much slower. Differences in prescribing patterns in different indications, age groups, and grades of hospitals were also founded.
Conclusion:
There has been a rapid increase in the use of OAC over the last 11 years in Shanghai, China. NOACs have been adopted rapidly, and have been gradually replacing warfarin. Warfarin remains the top choice for certain patients with valvular heart disease. Future studies are warranted considering changes in the OAC use in a larger scale, as well as the rationality and its influence factors on OAC use.
Insights
Oral anticoagulant prescriptions surged in Shanghai, with non-vitamin K antagonist oral anticoagulants (NOACs) rapidly replacing warfarin. Rivaroxaban became the dominant NOAC, despite rising costs.
Area of Science:
- Pharmacology and Therapeutics
- Cardiovascular Medicine
- Health Services Research
Background:
- Non-vitamin K antagonist oral anticoagulants (NOACs) offer an alternative to warfarin for preventing thromboembolism in conditions like atrial fibrillation (AF) and venous thromboembolism (VTE).
- Understanding prescribing trends of oral anticoagulants (OACs) is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To analyze the prescribing trends of OACs, including warfarin and NOACs, in Shanghai, China, from 2010 to 2020.
- To investigate the influence of indications, age groups, and hospital grades on OAC prescribing patterns.
Main Methods:
- Retrospective analysis of OAC prescription data from the Rx Analysis System (2010-2020).
- Comparison of OAC prescribing trends, costs, and contributions across different patient demographics and healthcare settings.
- Statistical analysis to identify significant trends and differences in OAC utilization.
Main Results:
- Overall OAC prescriptions showed a growing trend, with a significant increase in NOAC use since 2016 and a decrease in warfarin prescriptions since 2017.
- Rivaroxaban demonstrated a highly significant increase in prescriptions and emerged as the preferred NOAC for AF and VTE, dominating OAC costs.
- Prescribing patterns varied by indication, age, and hospital grade, with dabigatran and apixaban showing slower growth compared to rivaroxaban.
Conclusions:
- Oral anticoagulant use has rapidly increased in Shanghai over the past decade, with NOACs increasingly replacing warfarin.
- Warfarin remains a primary choice for specific patient groups, such as those with valvular heart disease.
- Further research is needed to evaluate the rationality and influencing factors of current OAC prescribing practices.
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