Direct Oral Anticoagulants’ Consumption and Expenditure in the COVID-19 Pandemic: A Critical Analysis

Zhoug Hui^*
*Correspondence: Zhoug Hui, Department of Medicine, Tianjin Medical University Cancer Institute & Hospital, Tianjing, 300060, China, Email:

Introduction

The COVID-19 pandemic has posed unprecedented challenges to healthcare systems worldwide. Beyond the direct impact on respiratory health, the virus has been associated with various complications, including thrombotic events. As a result, the consumption and expenditure on anticoagulant medications, particularly Direct Oral Anticoagulants (DOACs), have come under scrutiny. This article aims to critically analyze the consumption patterns and expenditure on DOACs during the COVID-19 pandemic [1].

DOACs have emerged as alternatives to traditional anticoagulants like warfarin due to their predictable pharmacokinetics, fewer drug interactions and fixed dosing regimens [2]. They include medications such as dabigatran, rivaroxaban, apixaban and edoxaban, which inhibit specific coagulation factors, thereby preventing thrombus formation. COVID-19 is associated with a hypercoagulable state, leading to an increased risk of thrombotic complications such as Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE) and stroke. Various factors contribute to this prothrombotic state, including inflammation, endothelial dysfunction, immobilization and the activation of coagulation pathways [3].

Description

During the pandemic, there has been a surge in the consumption of anticoagulants, including DOACs. Several studies have reported an increased incidence of thrombotic events among COVID-19 patients, necessitating anticoagulant therapy. Additionally, the avoidance of routine medical care and elective surgeries during lockdowns might have led to the delayed diagnosis of thrombotic events, further increasing the demand for anticoagulants. The increased consumption of DOACs has significant financial implications for healthcare systems. DOACs are generally more expensive than traditional anticoagulants like warfarin. Moreover, the higher prevalence of thrombotic complications in COVID-19 patients and the need for prolonged anticoagulant therapy contribute to increased expenditure [4].

Despite the effectiveness of DOACs, their high cost poses challenges to access and affordability, particularly in low- and middle-income countries. The pandemic has exacerbated these challenges, with healthcare systems struggling to allocate resources efficiently amidst competing priorities. The rise in DOAC consumption during the pandemic has strained healthcare budgets worldwide. Governments and healthcare payers face the dilemma of balancing the need to provide optimal care for COVID-19 patients while ensuring the sustainability of healthcare systems in the long term.

Healthcare institutions can develop formularies that prioritize cost-effective anticoagulant options without compromising patient outcomes. Governments and healthcare payers can negotiate with pharmaceutical companies to obtain favorable pricing for DOACs, thereby reducing overall expenditure. Implementing utilization management strategies such as prior authorization and step therapy can ensure appropriate prescribing of DOACs and prevent unnecessary expenditures. Encouraging the use of generic DOACs once they become available can significantly reduce costs while maintaining therapeutic efficacy [5].

Conclusion

The COVID-19 pandemic has led to a significant increase in the consumption and expenditure on DOACs due to the heightened risk of thrombotic events among infected individuals. This surge in demand poses financial challenges to healthcare systems, necessitating the implementation of cost-saving measures. By adopting strategies to optimize prescribing practices, negotiate drug prices and promote cost-effective alternatives, healthcare systems can ensure the sustainable provision of anticoagulant therapy amidst the ongoing pandemic.

Acknowledgement

None.

Conflict of Interest

None.

References

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