Abstract 16675: Assessment of Initial U.S. Dabigatran Utilization and Short-Term Persistence
Background: The U.S. Food and Drug Administration approved dabigatran in October 2010 to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation, and it became available in November 2010. The purpose of this analysis is to assess early US dabigatran utilization patterns and short-term persistence.
Methods: A retrospective analysis of a de-identified, integrated pharmacy-medical claims database is described. Patients with a prescription claim for dabigatran Nov 1-Dec 31, 2010, and with continuous eligibility of ≥12 months prior to and up to 4 months after initial dabigatran claim date were included. Demographic and clinical characteristics of patients, prescriber specialty, and 4-month persistence to dabigatran therapy were assessed. Medical diagnoses were determined by the presence of at least 2 ICD-9 or CPT codes in medical claims on 2 separate dates in the prior 12 months. Persistence at 120 days was calculated allowing a 45-day supply gap. Categorical and continuous variables were analyzed using chi-squared and t-tests, respectively (significance at p<0.05).
Results: A total of 1,143 patients received dabigatran mainly through retail pharmacy distribution (Table). Of these, 152 (13%) did not have a claims history for atrial fibrillation. Overall, cardiologists were the highest prescribers (62%), however primary care physicians prescribed in 23%. Warfarin therapy was prescribed in 71% of patients during the prior 6 months.
Conclusion: The 13% of patients with an unclear dabigatran indication appear distinct from those with atrial fibrillation. Overall, 17% do not persist on dabigatran therapy for 120 days, which may adversely affect stroke outcomes. Ongoing review and action on dabigatran patient selection and therapy maintenance to optimize clinical outcomes, as well as real-world comparative effectiveness with optimized warfarin therapy, are needed.
- © 2011 by American Heart Association, Inc.