Baseline patient characteristics and treatment follow-up period.

<p>Baseline patient characteristics and treatment follow-up period.</p

Discontinuation risk comparison among ‘real-world’ newly anticoagulated atrial fibrillation patients: Apixaban, warfarin, dabigatran, or rivaroxaban

<div><p>Discontinuation of oral anticoagulants may expose non-valvular atrial fibrillation (NVAF) patients to an increased risk of stroke. This study describes the real-world discontinuation rates and compared the risk of drug discontinuation among NVAF patients initiating apixaban, warfarin, dabigatran, or rivaroxaban. This retrospective cohort study evaluated newly-anticoagulated NVAF patients in the MarketScan^® data population from 01/01/2012 through 12/31/2014. Discontinuation was defined as a lack of subsequent prescription of the index drug within 30 days after the last supply day of the last prescription. A Cox model was used to estimate the hazard ratio (HR) of discontinuation, adjusted for age, sex, and comorbidities. Among 45,361 eligible NVAF patients, 15,461 (34.1%) initiated warfarin; 7,438 (16.4%) apixaban; 4,661 (10.3%) dabigatran; and 17,801 (39.2%) initiated rivaroxaban treatment. Compared to warfarin, patients who initiated dabigatran (adjusted HR [aHR]: 0.84, 95% confidence interval [CI]: 0.80–0.87, P<0.001), rivaroxaban (aHR: 0.70, 95% CI: 0.68–0.73, P<0.001), or apixaban (aHR: 0.57, 95% CI: 0.55–0.60, P<0.001) were 16%, 30%, and 43% less likely to discontinue treatment, respectively. When compared to apixaban, patients who initiated dabigatran (aHR: 1.46, 95% CI: 1.38–1.54, P<0.001) or rivaroxaban (aHR: 1.23, 95% CI: 1.17–1.28, P<0.001) were more likely to discontinue treatment. Among newly-anticoagulated NVAF patients in the real-world setting, initiation on rivaroxaban, dabigatran, or apixaban was associated with a significantly lower risk of discontinuation compared to warfarin. When compared to apixaban, patients who initiated treatment with warfarin, dabigatran, or rivaroxaban were more likely to discontinue treatment.</p></div

Patient selection criteria.

<p>Study population flow chart with inclusion and exclusion criteria used to select 45,361 patients. NOAC: non-vitamin K antagonist oral anticoagulant; VTE: venous thromboembolism.</p

Cumulative incidence of discontinuation among newly anticoagulated non-valvular atrial fibrillation patients.

<p>(Upper panel) Cumulative incidence of discontinuation during the follow-up period. The unadjusted cumulative incidence of discontinuation was lower among patients initiated on apixaban compared to patients inititated on other oral anticoagulants. (Lower panel) The number of patients at risk for discontinuation at varying points during the follow-up.</p

Study period depiction.

<p>Study period for patients initiating apixaban, dabigatran, rivaroxaban, and warfarin. AF: atrial fibrillation.</p

Adjusted hazard ratios of discontinuation.

<p>Adjusted hazard ratios of discontinuation.</p

Scenario analyses, societal perspective.

*<p>Mixed public and private incremental vaccine cost was calculated by weighing the public and private vaccine cost by the proportion of those who receive the vaccine at public cost.</p

Probabilistic sensitivity analysis, societal perspective.

<p>Probabilistic sensitivity analysis, societal perspective.</p

Incremental costs from vaccinating 10% of US population aged 65 years.

<p>Incremental costs from vaccinating 10% of US population aged 65 years.</p

Model inputs and sources for adults aged 65 years.

*<p>Vaccine cost was estimated as the incremental cost of Tdap versus Td and included drug acquisition cost and cost of vaccine adverse events (Lee 2007).</p>**<p>Cost is lost productivity per case and is applied to moderate and severe cases only.</p><p>PSA = probabilistic sensitivity analysis.</p