Estimated medical cost reductions associated with use of novel oral anticoagulants vs warfarin in a real-world non-valvular atrial fibrillation patient population.

OBJECTIVE: RESULTS of randomized clinical trials (RCT) demonstrate that novel oral anticoagulants (NOAC) are effective therapies for reducing the risk of stroke in non-valvular atrial fibrillation (NVAF). Prior medical cost avoidance studies have used warfarin event rates from RCTs, which may differ from patients receiving treatment in a real-world (RW) setting, where the quality of care may not be the same as in a RCT. The purpose of this study was to estimate the change in medical costs related to stroke and major bleeding for each NOAC (apixaban, dabigatran, and rivoraxaban) relative to warfarin in a RW NVAF population. METHODS: Patients (n = 23,525) with a diagnosis of NVAF during 2007-2010 were selected from a Medco population of US health plans. Stroke and major bleeding excluding intracranial hemorrhage (MBEIH) events were identified using diagnosis codes on medical claims. RW reference event rates were calculated during periods of warfarin exposure. RW event rates for NOACs were estimated by multiplying the corresponding relative risk (RR) from the RCTs by each reference rate. Absolute risk reductions (ARR) or number of events avoided per patient year were then estimated. Changes in medical costs associated with each NOAC were calculated by applying the ARR to the 1-year cost for each event. Costs for stroke and MBEIH were obtained from the literature. Drug and international normalized ratio monitoring costs were not considered in this analysis. RESULTS: Compared to RW warfarin, use of apixaban and dabigatran resulted in total (stroke plus MBEIH) medical cost reductions of $1245 and $555, respectively, during a patient year. Rivaroxaban resulted in a medical cost increase of $144. CONCLUSIONS: If relative risk reductions demonstrated in RCTs persist in a RW setting, apixaban would confer the greatest medical cost savings vs warfarin, resulting from significantly lower rates of both stroke and MBEIH.

Comparative Study of Medical Cost about Generic Drugs Use Promotion of Eye Drops / 医薬品情報学

<b>Objective: </b>From the viewpoint of drug cost reduction, many generic drugs have appeared in the eye drops market.  Although the price of eye drops is defined on a per bottle (or per mL) basis, the difference in the total number of drops per bottle between the original drug and its generic drug may alter the drug cost reduction effect greatly.  Moreover, the difference in the total number of drops per bottle may also affect the number of pharmacy visits made by a patient in one year.<br><b>Methods: </b>The total number of drops per bottle of an original drug and a generic drug was computed, and the influence of the number of drops on the drug cost reduction effect, including drug cost, was evaluated.<br><b>Results: </b>Distinct differences in the volume per drop and the total number of drops per bottle were observed between the original drug and its generic drug, and those differences were found to clearly influence the drug cost reduction effect.  Moreover, in a survey of patients who shifted to generic eye drops, there were some patients who returned to the original eye drops because they could not apply the generic eye drops with ease or their eyes started to smart after using the generic eye drops.<br><b>Conclusion: </b>This study revealed the need to take into consideration patient’s ease of use and the drug cost reduction effect, in the selection of eye drops.