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The Effects of Removing the Requirement for Prior Reimbursement Approval on Anticoagulant Use in Ireland: A

M Scannell1, E Burton1, P M Kearney1

  • 1School of Public Health, University College Cork, Cork, Ireland.

Pharmacoepidemiology and Drug Safety
|October 13, 2024
PubMed

Insights

Prior approval for direct oral anticoagulants (DOACs) in Ireland had minimal impact on prescribing trends. Removing this cost containment policy did not significantly alter the overall use of oral anticoagulants.

Area of Science:

  • Health Economics
  • Pharmacoeconomics
  • Public Health Policy

Background:

  • Prior approval for medication reimbursement is a cost containment strategy.
  • Ireland implemented prior approval for direct oral anticoagulants (DOACs) due to financial pressures from the shift from warfarin.
  • Limited studies exist on the effectiveness of prior approval policies for DOACs.

Purpose of the Study:

  • To evaluate the effectiveness of prior approval for reimbursement of apixaban and rivaroxaban as a cost containment measure in Ireland.
  • To analyze the impact of prior approval policies on the prescribing patterns of oral anticoagulants.

Main Methods:

  • Cross-sectional study using the Irish Health Service Executive-Primary Care Reimbursement Service database (2018-2021).
  • Analysis of prescribing frequencies and costs of oral anticoagulants (apixaban, rivaroxaban, warfarin).
  • Time series negative binomial regression to assess the impact of removing prior approval requirements.

Main Results:

  • Overall oral anticoagulant prescribing frequency increased by nearly 20% between 2018 and 2021.
  • Significant variations in oral anticoagulant prescribing proportions were observed across Community Drug Schemes.
  • A statistically significant decrease in apixaban use (<1%) was noted after prior approval removal.

Conclusions:

  • Removal of prior approval for DOAC reimbursement in Ireland had a minimal effect on overall oral anticoagulant prescribing trends.
  • Healthcare systems should carefully consider drug type, approval criteria, and policy duration when implementing prior approval policies.
  • Minimizing negative effects associated with prior approval policies requires careful planning and evaluation.
Abstract

Keywords:
anti‐coagulantscost containment policiesinterrupted time series analysisprescribing frequency

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