How best to choose a direct oral anticoagulant (DOAC) for atrial fibrillation is challenging, because head-to-head trial data comparing agents are unavailable. In this population-based cohort study... Visual Comparative Effectiveness and Safety Between Direct Oral Anticoagulants. How best to choose a direct oral anticoagulant (DOAC) for atrial fibrillation is challenging, because head-t... Background: Current guidelines recommend using direct oral anticoagulants (DOACs) over warfarin in patients with atrial fibrillation (AF), but head-to-head trial data do not exist to guide the choi...

Importance Drug production not meeting the demand leaves affected patients in a vulnerable position. Objective To describe incidence and prevalence of medicines with suggested shortages in at least one European country Design We performed a descriptive cohort study between 2010 in a network of databases which have mapped their data to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). Setting Setting included primary care, secondary care, and various disease registries whose previously collected data was leveraged. Participants We included all patients with at least 365 days of history on the database. Exposures We investigated all medicines with a suggested shortage in at least one European country for more than 365 days (n=18). Furthermore, we assessed their alternatives as well (n=39). Main outcomes and measures We estimated annual incidence rates and period prevalence of all medicines with suggested shortages and their alternatives. A drop in incidence or prevalence of more than 33% after the shortage announce by the European Medicines Agency was considered confirmation of a shortage. Results Among 41 databases from Europe and the United States, we observed shortages according to incidence for 12 drugs and shortages according to prevalence for 4 drugs. The drugs varenicline, cetrorelix, and amoxicillin plus clavulanate were in shortage in the most countries. Conclusion and relevance We compiled and analysed data of annual incidence and prevalence of 57 medicines among 41 databases in Europe and the United States. We detected shortages of several drugs and suggest monitoring and stewardship for drug availability.