Adherence and persistence to rivaroxaban in non-valvular atrial fibrillation patients receiving 30- or 90-day supply prescription fills

Abstract

Background

It is unclear whether 90-day supply fills with rivaroxaban result in better adherence and persistence compared to 30-day supply fills. We assessed patients’ adherence and persistence to rivaroxaban at 12- and 24-months in nonvalvular atrial fibrillation (NVAF) patients whose rivaroxaban prescriptions were filled every 30- vs. 90-days.

Methods

Using the IBM MarketScan Commercial and Medicare Supplemental data sets, we identified adult NVAF patients with ≥12-months of continuous insurance coverage who filled a prescription in May 2018 and their immediate subsequent prescription for rivaroxaban for the same days’ supply. We propensity score-matched 30- and 90-day rivaroxaban interval fill patients and compared the percentage with a proportion of days covered (PDC) ≥80%, mean PDC, and percentage persistent to rivaroxaban therapy over 12- and 24-months of follow-up.

Results

Following propensity score matching, 2237 patients were included in the rivaroxaban 30- and 90-day supply fill cohorts. The proportion of patients with a PDC ≥80% was greater in the 90-day vs. 30-day cohort at both 12-months (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.54–1.97) and 24-months (OR = 1.78, 95%CI = 1.58–2.00), as were mean PDC values (absolute difference in mean PDC = 9.4%, 95%CI = 8.2–10.7% at 12-months and 11.2%, 95%CI = 9.5–12.9% higher at 24-months, respectively). Persistence to rivaroxaban was not found to significantly differ between the 30- and 90-day supply cohorts at 12- or 24-months (assuming a 30-day permissible gap); however, greater persistence was observed with 90-day fills at both time points when a 14-day gap was utilized (HR = 1.22, 95%CI = 1.10–1.36 at 12-months and HR = 1.12, 95%CI = 1.02–1.22 at 24-months).

Conclusions

Dispensing 90-day supply fills with rivaroxaban appears to increase the proportion of patients achieving acceptable (PDC ≥80%) adherence as well as mean adherence compared to 30-day supply fills. Ninety-day rivaroxaban fills may also result in improved persistence vs. 30-day fills.

Keywords:

• Rivaroxaban
• nonvalvular atrial fibrillation
• adherence
• persistence
• days’ supply

Transparency

Declaration of funding

This study was supported by Janssen Scientific Affairs, LLC, Titusville, NJ, USA. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Declaration of financial/other relationships

CIC has received research funding and honoraria from Janssen Scientific Affairs, LLC; Bayer AG; and Alexion Pharmaceuticals. VA is an employee of Janssen Pharmaceuticals. TJB has not conflicts to declare. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work but have no other relevant financial relationships to disclose.

Author contributions

All authors had a role in study design; data collection, analysis, and interpretation of data; writing the report; and approved the manuscript for submission.

Acknowledgements

None declared.

Ethical approval

All IBM MarketScan data are de-identified, and thus are in compliance with the Health Insurance Portability and Accountability Act of 1996 to preserve patient anonymity and confidentiality. This study was deemed exempt for institutional review board oversight.