Comparative effectiveness analysis of the choice of non-vitamin K oral anticoagulant (NOAC) as first line therapy for patients with non-valvular atrial fibrillation (NVAF)

use case on value-based contracting

Challenge

Understanding the real-world comparative effectiveness of NOACs is challenging due to bias arising from clinical practice (confounding by indication, specifically).

Solution

  • We applied an instrumental variable design that leveraged prescriber information to limit confounding by measured and unmeasured confounding factors, such as baseline differences in comorbidity burden and risk of bleeding.
  • Used OM1 linked clinical EMR and claims data and our databases of provider information to execute this RWD CER design.

Total AF patients who met study eligibility criteria

of the total AF patients were treated with Rivaroxaban as first line therapy

of the total AF patients were treated with Apixaban as first line therapy