IMPACT OF NON-VITAMIN K ORAL ANTI-COAGULANTS ON WARFARIN UTILISATION AND NHS BUDGET IN UK

Abstract

Introduction: Vitamin K anticoagulants were the mainstay prophylaxis of stroke in patients with atrial fibrillation and thromboembolic diseases. Non-vitamin K oral anticoagulants were approved for use in UK. To evaluate the impact of the introduction and change in guidelines on the utilisation of newer agents on the prescribing oral anticoagulants in UK. Methods: A segmented regression of interrupted time series analysis of the primary care data of oral anticoagulants from England, Scotland, Northern Ireland, and Wales between 2001 and 2021. Results: The overall utilisation of oral anticoagulants increased from 85.8, 9, 2.8, and 7.3 million defined daily doses in 2001 to 430, 36, 14.1, and 26.5 million defined daily doses in 2021 in England, Scotland, Northern Ireland, and Wales respectively. In 2021, the market domination changed from warfarin to apixaban. Segmented regression analysis showed that with the change in the National Institute for Health and Care Excellence clinical guidance in 2014, the utilisation of vitamin K anticoagulants decreased significantly by 2.39e+07, 1675341, 604863 and 2065009 defined daily doses annually in England, Scotland, Northern Ireland, and Wales, respectively. The overall expenditure on oral anticoagulants increased from £16, £1.6, £0.5, and £1.3 million in 2001 to £751, £60, £25, and £44.5 million in 2021 in England, Scotland, Northern Ireland, and Wales respectively. Conclusion: Prescribing oral anticoagulants changed in response to the change in clinical guidance. This suggests that the UK physicians followed evidence-based practice and changed to nonvitamin K oral anticoagulants primarily when recommended by the National Institute for Health and Care Excellence.

Keywords

• Warfarin
• dabigatran
• rivaroxaban
• apixaban
• edoxaban