Evidence map›Paper›PMID 37568060›Full record

ArticleAdvances in therapy2023

Unintended Consequences of Increased Out-of-Pocket Costs During Medicare Coverage Gap on Anticoagulant Discontinuation and Stroke.

Tabassum Salam, Urvi Desai, Patrick Lefebvre, E Jian-Yu, Alexandra Greatsinger, Nina Zacharia, François Laliberté, Brahim Bookhart, Akshay Kharat

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Advances in therapy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.9field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 4 citations in OpenAlex.

  1. Inequalities in oral anticoagulant treatment patterns: a two-part model to estimate healthcare costs associated with atrial fibrillation.The European journal of health economics : HEPAC : health economics in prevention and care · 2026
    Article
  2. Article
  3. Article
  4. Factors associated with medication adherence trajectory among patients treated with oral anticancer drugs: a multicentre cohort study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
    Observational
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Tabassum SalamChristiana Care, Newark, DE, USA.
Urvi DesaiAnalysis Group, Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA. urvi.desai@analysisgroup.com.ORCID http://orcid.org/0000-0001-5196-7201
Patrick LefebvreGroupe d'analyse, Ltée, Montreal, QC, Canada.
E Jian-YuAnalysis Group, Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA.
Alexandra GreatsingerAnalysis Group, Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA.
Nina ZachariaAnalysis Group, Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA.
François LalibertéGroupe d'analyse, Ltée, Montreal, QC, Canada.
Brahim BookhartJanssen Scientific Affairs, LLC, Titusville, NJ, USA.
Akshay KharatJanssen Scientific Affairs, LLC, Titusville, NJ, USA.
Analysis Group (United States) · USJanssen (United States) · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThis study aims to assess the risk of direct oral anticoagulant (DOAC) discontinuation among Medicare beneficiaries with non-valvular atrial fibrillation (NVAF) who reach the Medicare coverage gap stratified by low-income subsidy (LIS) status and the impact of DOAC discontinuation on rates of stroke and systemic embolism (SE) among beneficiaries with increased out-of-pocket (OOP) costs due to not receiving LIS.

methodsIn this retrospective cohort study, Medicare claims data (2015-2020) were used to identify beneficiaries with NVAF who initiated rivaroxaban or apixaban and entered the coverage gap during ≥ 1 year. DOAC discontinuation rates during the coverage gap were stratified by receipt of Medicare Part D Low-Income Subsidy (LIS), a proxy for not experiencing increased OOP costs. Among non-LIS beneficiaries, incidence rates of stroke and SE during the subsequent 12 months were compared between beneficiaries who did and did not discontinue DOAC in the coverage gap.

resultsAmong 303,695 beneficiaries, mean age was 77.3 years, and 28% received LIS. After adjusting for baseline differences, non-LIS beneficiaries (N = 218,838) had 78% higher risk of discontinuing DOAC during the coverage gap vs. LIS recipients (adjusted hazard ratio [aHR], 1.78; 95% CI [1.73, 1.82]). Among non-LIS beneficiaries, DOAC discontinuation during coverage gap (N = 91,397; 34%) was associated with 14% higher risk of experiencing stroke and SE during the subsequent 12 months (aHR, 1.14; 95% CI [1.08, 1.20]).

conclusionIncreased OOP costs during Medicare coverage gap were associated with higher risk of DOAC discontinuation, which in turn was associated with higher risk of stroke and SE among beneficiaries with NVAF.

Indexed as

Atrial FibrillationMedicare Part DStrokeAgedAnticoagulantsHealth ExpendituresHumansRetrospective StudiesUnited StatesAnticoagulantsAtrial fibrillationDirect oral anticoagulantsDiscontinuation ratesMedicare coverage gapOut-of-pocket costsStrokeSystemic embolism

Identifiers

PMID37568060
PMCPMC10499728
OpenAlexW4385754387

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.