PB0243 - Trends in Vitamin K antagonist use indicate prescription patterns that may be over-utilizing Direct Oral Anticoagulants without adequate gains in side effect profile or improved cost-effectiveness.

Background: Cost of healthcare continue to escalate. In 2018, Medicare outlay for healthcare was 750.2 billion. Over utilization of newer medications are a major reason. We analyze contribution of Apixaban to healthcare costs over 5 years from 2018 to 2022.

Aims: To analyze prescription patterns, cost increases and side effect benefits of Apixaban over Warfarin between 2018 and 2022.

Methods: Health care costs were obtained from Medicare. Cost of Warfarin and Apixaban were obtained from private pharmacies and Medicare. Costs were analyzed for 30-day supply. Data was collected on number of prescriptions during first quarter of 2018 and 2022. Change in prescription numbers was used to project cost increases in Medicare for Apixaban. Data on life-threatening bleeding and non-life-threatening events between Warfarin and Apixaban were compared.

Results: Data from first quarter of 2018 showed 379/626 prescriptions for Warfarin and 247/626 for Apixaban indicating 39.45% prescriptions for Apixaban. During first quarter of 2022 it was 745/1911 and 1166/1911 respectively. This represents a 54.37% increase in number of Apixaban prescriptions over 5 years. Costs for 30-days of 5 mg pills of Warfarin is $11. With Apixaban, the coverage charged is $635. Medicare spending in 2018 on Apixaban was $5 billion. With this prescription change, projected cost for Apixaban is $7.7 Billion in 2022. With side effect profile, data from ARISTOTLE show that number of major bleeding with Apixaban was 0.525/Year and 1.13%/Year with Warfarin, ischemic stroke were 0.97% and 1.05% and venous thromboembolism 0.09% and 0.10% and Mortality 3.52% and 3.94% respectively.

Conclusion(s): Apixaban adds $7.7 Billion to health care based on prescription changes between 2018 and 2022. This is not based on cost-effective improvements in side effects or mortality. Considering this, it may be necessary to evaluate benefits of continued use of Warfarin and limit use of Apixaban to select populations to manage increasing healthcare costs.