Key result
Oral anticoagulant prescriptions increasingly favor DOACs, driving 2023 costs to ~$500M before generic-driven declines.
Why the study?
The authors sought to evaluate oral anticoagulant usage and cost trends over time in Australia, particularly across the COVID-19 pandemic and its transition to an endemic phase.
Observational
Despite increasing use of DOACs over VKAs and rising costs reaching half a billion dollars in 2023, the introduction of generics has begun to reduce costs, and the COVID-19 pandemic did not significantly alter prescription trends in Australia.
Generic availability is curbing rising DOAC costs in Australia; supports utilization surveillance but leaves open effects on outcomes and access.
Background/Objectives: Oral anticoagulant (OA) therapy (OAT) may be prescribed to patients for a variety of reasons, with several agent classes currently available as well as emerging. The classical oral anticoagulants are represented by vitamin K antagonists (VKAs), including warfarin, and the more modern alternatives comprise the direct oral anticoagulants (DOACs). We aimed to assess usage of OAs over time in Australia, especially focusing on the period of the coronavirus disease 2019 (COVID-19) pandemic and its transition to an endemic phase, to assess for any trends. Methods: Using data from the pharmaceutical benefits scheme (PBS), Medicare and other online sites, we specifically assessed for changes in OA prescription and cost patterns over the period 1992–2024, but focusing especially on the period 2020–2024 inclusive. Results: Apixaban is now the most prescribed OA in Australia. Costs of OAT prescriptions have steadily increased over the data capture period, reaching half a billion dollars in 2023. Interestingly, costs have started to fall, seemingly driven by the release of DOAC generics and PBS pricing adjustments. We could identify no clear signals related to COVID-19-related changes in prescription trends, contrary to previous reports in other locations. Conclusions: We provide Australian data on both OA usage as well as costs. Despite an ongoing trend to increasing use of DOACs over VKAs, we could not identify any specific COVID-19-related changes.
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Favaloro et al. (2025) conducted an observational in Oral anticoagulant therapy. Oral anticoagulants was evaluated on Changes in oral anticoagulant prescription and cost patterns. Oral anticoagulant prescriptions in Australia increasingly favored DOACs like apixaban, with total costs reaching half a billion dollars in 2023 before declining due to generic availability.
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