Initiation and continuation of oral anticoagulant prescriptions for stroke prevention in non-valvular atrial fibrillation: A cohort study in primary care in France

Collings, Shuk-Li; Vannier-Moreau, V.; Johnson, Michelle; Stynes, G.; Lefèvre, Cinira; Maguire, Andrew; Asmar, Joelle; Bizouard, Geoffray; Duhot, Didier; Mouquet, Frédéric; Fauchier, Laurent

doi:10.1016/j.acvd.2017.10.003

Cited by 16 publications

(25 citation statements)

References 30 publications

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“…The high non‐persistence rates of DOAC use amongst patient with atrial fibrillation found in our study (34% for DOACs, 26% for apixaban, 27% for dabigatran and 42% for rivaroxaban, all at 1 year) were comparable to the non‐persistence found in other observational studies of patients using either VKA or DOACs after 1 year in which close patient monitoring was lacking. Neither Germany or France have specialized anticoagulant clinics to monitor VKA users.…”

Section: Discussionsupporting

confidence: 74%

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Zielinski

Rein

Teichert

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: In contrast to vitamin K antagonists (VKA), direct oral anticoagulants (DOAC's) are not strictly monitored and dose titrated by anticoagulation clinics in the Netherlands. This may affect drug persistence of atrial fibrillation (AF) patients, whom often require lifelong treatment.Objectives: To assess persistence of DOACs and of VKAs in patients with AF.

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Section: Discussionsupporting

confidence: 74%

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Zielinski

Rein

Teichert

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…Third, the persistence rate from the VKA arm was taken from an US study [14] as no relevant French data were identified. However, the proportion of switch among the patients who discontinued their initial treatment was taken from a French study focussing on primary care [15]. Finally, multiple health states exist in the model with the possibility for patients to transition between all of them.…”

Section: Discussionmentioning

confidence: 99%

“…For each treatment, discontinuation probabilities were divided into different time periods (initiation-3 months, 3 months-6 months, 6 months-1 year, and >1 year). For the VKA arm, treatment discontinuation and switch rates were derived from RWE studies [10,15]. For the rivaroxaban arm, the HR of discontinuation from the RWE meta-analysis and the switch rate from a RWE French study [10,15] were used.…”

Section: Clinical Data Implementationmentioning

confidence: 99%

Real-world cost-effectiveness of rivaroxaban compared with vitamin K antagonists in the context of stroke prevention in atrial fibrillation in France

et al. 2020

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ObjectiveThe objective was to assess the real-world cost-effectiveness of rivaroxaban, versus vitamin K antagonists (VKAs), for stroke prevention in patients with atrial fibrillation (AF) from a French national health insurance perspective.Funding: LF, CC and PL received honorarium from Bayer AG for critical input into study design and results analysis. Bayer Plc. provided support in the form of salaries for author KB; Bayer AG provided support in the form of salaries for author JBB. Bayer AG sponsored the study, and Bayer AG as well as Bayer Plc had a role in the study design, ConclusionsAlthough there is no official willingness-to-pay threshold in France, these results suggest that rivaroxaban is likely to be cost-effective compared to VKA in French patients with AF from a national insurance perspective. Introduction/BackgroundAtrial fibrillation (AF) is a cardiac arrhythmia with structural and/or electrophysiological abnormalities that induce remodelling in the atria; it is the most common cardiac arrhythmia [1][2][3]. Worldwide, an estimated 3% of adults aged 20 years or older suffer from AF, approximately 20.9 million men and 12.6 million women [2]. Due to the aging of the population, the worldwide prevalence is predicted to at least double in many countries during the next several decades [4,5].AF is associated with substantial morbidity and mortality [2]. Compared to otherwise healthy individuals, men and women with AF are at a 1.5-fold and 2-fold increased risk for allcause mortality, respectively [2], and the risk for strokes increased by 2-to-7-fold [4]. Strokes are associated with significant financial burden [6]; in 2015, the total costs of stroke care in the European Union (EU) was estimated to be €45 billion euros [7]. It is expected that between 2015 and 2035, there will be a 34% increase in total number of stroke events in the European Union [7].Oral anticoagulants including vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) such as rivaroxaban, dabigatran, apixaban, and edoxaban, have been established as a cornerstone of management in patients with AF and to reduce stroke incidence and mortality [2] in randomized clinical trials (RCTs) [2].Many uncertainties remain regarding the relevance of the results of RCTs in a real-world setting. Real-world evidence (RWE) may provide additional information to decision-makers [8]. Indeed, RWE sample size is not limited as it is the case of RCTs. RCTs have to respect inclusion/exclusion criteria regarding population selection. Also, RWE can offer long-term outcomes while the timeframe of RCT is usually shorter with only a few outcomes [9].A meta-analysis comparing NOACs with VKAs and reporting effectiveness, safety, and persistence using RWE has recently been published [10]. It confirmed the findings of rivaroxaban pivotal RCT [11] and concluded that rivaroxaban is a suitable alternative to VKAs in routine clinical practice. Health Technology Assessment (HTA) agencies are frequently requesting manufacturers to prove the benefits of their hea...

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“…A French cohort study using the IMS Longitudinal Patient Database compared medication non-persistence, defined as treatment discontinuation (no prescription for > 60 days) or switch, between dabigatran and warfarin initiators. 397 Nonpersistence was higher with dabigatran compared to warfarin (HR 1.42, 95% CI 1. 20-1.69).…”

Section: Medication Adherencementioning

confidence: 99%

“…[23][24][25][26]113,232,233,288,375 Two studies were unclear or did not report a geographical location. 115,366 Seventy-five studies were considered of good quality or had a low risk of bias rating, 23-26,112,113,115,127,173,177,207,208,214,218,219,228-230,232,233,250,255,258,259,267-269,275,276,287,288,293,294,297,299,300,303-305,310,311,320-322,327,329,330,339,346,347,362,365,366,370,373,376,379-382,387,388,391-393,395,396,398,400-402,405-409 16 were considered fair quality or had a moderate risk of bias rating, 215,289,315,350,354,358,371,375,[383][384][385][386]389,394,397,403 and 26 were of poor quality or had a high risk of bias rating. 141,220,221,226,227,238,239,253,257,262,264,266,273,292,295,298,302,[307][308]…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update

Sanders¹,

Lowenstern²,

Borre³

et al. 2018

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The information in this report is intended to help health care decisionmakers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.This report is made available to the public under the terms of a licensing agreement between the author and AHRQ. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. PCORI, AHRQ, or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at: www.effectivehealthcare.ahrq.gov. Search on the title of the report.

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Initiation and continuation of oral anticoagulant prescriptions for stroke prevention in non-valvular atrial fibrillation: A cohort study in primary care in France

Cited by 16 publications

References 30 publications

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Real-world cost-effectiveness of rivaroxaban compared with vitamin K antagonists in the context of stroke prevention in atrial fibrillation in France

Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update

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