11institutetext:
Knowledge-based Systems and Document Processing Research Group
Faculty of Computer Science
Otto-von-Guericke-University Magdeburg
11email: katrin.krieger@ovgu.de
The effects of removing the requirement for prior reimbursement approval
on anticoagulant use in Ireland: A cross sectional study.
Abstract
Purpose Prior approval for reimbursement is a cost containment
policy, aimed at reducing demand. It has been employed in Ireland to
address financial challenges due to the shift from warfarin to Direct
Oral Anticoagulant (DOACs). Studies assessing the effectiveness of this
policy are limited. Thus, we aimed to examine the effectiveness of prior
approval for reimbursement of DOACs (apixaban, rivaroxaban) as a cost
containment policy in Ireland. Methods The Irish Health Service
Executive-Primary Care Reimbursement Service database was used in this
cross-sectional study. We examined the prescribing frequencies and
associated costs of the oral anticoagulants; ((OACs) apixaban,
rivaroxaban, and warfarin) listed in the top 100 most frequently
prescribed drugs, between 2018 and 2021. Interrupted time series Poisson
regression was used to assess the impact of removing the approval
requirement of apixaban in September 2019 followed by the other DOACs in
November 2020. Results The prescribing frequency of OACs
increased by almost 20% from 2018-2021. This study showed there were
significant differences in the proportion of OACs prescribed among the
Community Drug Schemes. A statistically significant decreased use of
apixaban (<1%, p<0.05) occurred when prior approval was
removed for all DOACs. Conclusions The removal of prior
approval for reimbursement of DOACs in Ireland had a minimal impact on
the prescribing frequency trends of the OACs. Future use of these
potentially useful policies by healthcare systems requires careful
consideration of drug type, approval criteria and length of time the
policy remains in place to minimise any negative effects associated with
their use.