Supplementary materials: Impact of comparative effectiveness research on Medicare coverage of direct oral anticoagulants

These are peer-reviewed supplementary materials for the article 'Impact of comparative effectiveness research on Medicare coverage of direct oral anticoagulants' published in the Journal of Comparative Effectiveness Research.Appendix 1: Summary of the key characteristics of the included studies (n=39)Appendix 2: Change points identified for the five outcome variables using Binary Segmentation change point analysis for dabigatran, rivaroxaban and apixaban.Appendix 3: CPA plot displaying the percentage of the Medicare plans covering each DOAC with quantity limit from 2011-2017.Appendix 4: CPA plot displaying the percentage of the Medicare plans covering each DOAC under prior authorization from 2011-2017.Appendix 5: CPA plots displaying the percentage of the Medicare plans covering each DOAC with type of cost sharing at preferred pharmacies (0= not offered, 1= copay, 2= coinsurance) from 2011-2017.Appendix 6: CPA plot displaying the mean percentages of coinsurance (i.e. type of cost sharing) at preferred pharmacies for each DOAC from 2011-2017.Aim: To evaluate the association of comparative effectiveness research with Medicare coverage of direct oral anticoagulants. Materials & methods: A literature review for direct oral anticoagulants was conducted from 2011 to 2017. Monthly prescription drug plan and formulary files (n = 28) were used to conduct change-point analysis and assess each outcome variable. Results: Up to 2013, studies showed that dabigatran was more effective than rivaroxaban. In 2015, apixaban was shown to be the safest and most effective drug in comparison with all direct oral anticoagulants. In 2016–2017, dabigatran and apixaban were shown to have similar efficacy. Approximately 75% of plans covered dabigatran under tier 3 until 2015. From 2011 to 2017, less than 30% of plans required prior authorizations, 50% imposed quantity limits and mean copayment was lowest for rivaroxaban. Conclusion: Consistent with comparative effectiveness research, Medicare plans covered apixaban more favorably and edoxaban less favorably. However, discrepancies in comparative effectiveness research translation were found for rivaroxaban and dabigatran.

本数据集为发表于《比较效果研究杂志》之文章《比较效果研究对医疗保险直接口服抗凝剂覆盖范围的影响》的同行评审补充材料。附录1：纳入研究的核心特征概要（n=39）；附录2：利用二分割变化点分析识别的五种结局变量的变化点，涉及达比加群、利伐沙班和阿哌沙班；附录3：2011-2017年间，显示医疗保险计划对每种直接口服抗凝剂实施数量限制的CPA图；附录4：2011-2017年间，显示医疗保险计划在预先授权下覆盖每种直接口服抗凝剂的CPA图；附录5：2011-2017年间，显示医疗保险计划在首选药店实施成本共担类型的CPA图，其中0=未提供，1=共付，2=共同保险；附录6：2011-2017年间，显示每种直接口服抗凝剂在首选药店平均共同保险比例（即成本共担类型）的CPA图。研究目的：评估比较效果研究与医疗保险直接口服抗凝剂覆盖范围之间的关联。研究方法：对2011年至2017年间直接口服抗凝剂的文献进行了综述。利用2011年至2017年每月的处方药物计划和处方药目录文件（n=28）进行变化点分析和评估每个结局变量。研究结果：截至2013年，研究表明达比加群比利伐沙班更有效。2015年，与所有直接口服抗凝剂相比，阿哌沙班被证明是最安全且最有效的药物。2016-2017年，研究表明达比加群和阿哌沙班的疗效相似。直到2015年，约75%的计划在三级覆盖下涵盖达比加群。2011年至2017年间，不到30%的计划需要预先授权，50%实施数量限制，平均共付金额对于利伐沙班最低。研究结论：与比较效果研究一致，医疗保险计划更有利于覆盖阿哌沙班，而对艾多沙班的覆盖则相对不利。然而，在利伐沙班和达比加群的比较效果研究中发现了翻译差异。