Direct Oral Anticoagulants Utilization and Expenditure in the Pharmacy Segment During the COVID-19 Pandemic in Russia

BACKGROUND: The analysis of direct oral anticoagulants use in outpatients with coronavirus infection and their utilization in the pharmacy segment is an essential task of modern healthcare. AIM: This work aimed to analyze the outpatient utilization of direct oral anticoagulants in the pharmacy segment of the Russian pharmaceutical market during the COVID-19 pandemic based on the national guidelines. MATERIAL AND METHODS: We calculated the utilization of direct oral anticoagulants (rivaroxaban and apixaban) at defined daily doses in all registered outpatients with COVID-19 in the pharmacy segment of the pharmaceutical market (24,343,383 people). This was done by determining the total utilization of these drugs each year of the pandemic (2020–2023) in Russia and dividing the obtained value by the defined daily dose recommended by the World Health Organization. Then we compared the results with the course doses recommended in the Russian guidelines issued in 2020–2023 for direct oral anticoagulants use in patients with COVID-19. RESULTS: In 2020, the hypothetical utilization of apixaban and rivaroxaban by outpatients with COVID-19 in Russia in 2020 was 76.6 defined daily doses per patient. In 2021, apixaban utilization decreased to values comparable to the recommended doses (21.1 defined daily doses), while rivaroxaban utilization was 10.6. In 2022, the defined daily doses for apixaban and rivaroxaban were 9.2 and 4.2, respectively. CONCLUSION: In 2020, the utilization of direct oral anticoagulants (apixaban and rivaroxaban) in outpatients with COVID-19 exceeded Russian guideline-recommended dosing regimens by more than fivefold, with a downward trend in the following pandemic years.