Medicare part D prescribing for direct oral anticoagulants in the United States: Cost, use and the "rubber effect".
Medicare part D prescribing for direct oral anticoagulants in the United States: Cost, use and the "rubber effect".
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DOI：
10.1371/journal.pone.0198674
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Mylonakis E
中科院分区：
文献类型：
--
作者：
Ziakas PD;Kourbeti IS;Poulou LS;Vlachogeorgos GS;Mylonakis E
直接口服抗凝剂（DOAC）在预防和治疗血栓栓塞性疾病方面的份额超过华法林。我们研究了DOAC在供应商和医疗专业中的采用情况。2013年至2015年医疗保险D部分公共使用文件（PUF）的回顾性横断面分析。我们总结了索赔和药物支付的处方数据，按药物类别、专业和日历年分层。我们将DOAC索赔视为计数结果，并通过截断负二项回归探索了处方医生之间的扩展模式。我们描述了DOAC处方在各医院转诊区域（HRR）的分散和传播，包括p90/p10比值和中位数绝对偏差。在2015年D部分PUF中，口服抗凝剂索赔已攀升至约2440万，支付成本约为33亿美元。DOAC索赔占口服抗凝剂索赔的31.0%，与2013年相比相对增加约127%。处方者的上十分位数占口服抗凝剂处方和由此产生的成本的一半。2015年DOAC索赔的中位成本为367.4美元（四分位数范围323.9至445.9），而华法林为12.3美元（四分位数范围9.2至16.5）。DOAC和华法林的标准化（30天供应）处方的中位成本分别为317.0美元（四分位数范围303.8至324.3）和8.0美元（6.7至9.8）。DOAC的采用因专业而异。心脏病学家、心脏电生理学家和骨科的DOAC预测份额最高（2015年分别为53.8、72.9和71.5）;肾病学家、家庭医生和老年病学家最低（2015年分别为22.3、21.5和20.7）。在不同的HRR中，p90/p10比值和与中位数的绝对偏差中位数各不相同，并且与Medicare人群中卒中和房颤的患病率呈正相关。DOAC的份额逐年增加，但各专业的采用情况各不相同。在中风和房颤的流行地区，处方分散度放大，这可能意味着顶级供应商的快速采用。
Direct oral anticoagulants (DOAC) have gained an increased share over warfarin for prevention and treatment of thromboembolic disease. We studied DOAC adoption across providers and medical specialties. Retrospective, cross-sectional analysis of Medicare Part D public use files (PUF), 2013 to 2015. We summarized prescription data for claims and drug payment, stratified by drug class, specialty and calendar year. We treated DOAC claims as a count outcome and explored patterns of expansion across prescribers via a truncated negative binomial regression. We described dispersion and spread in DOAC prescribing, across hospital referral regions (HRRs), including the p90/p10 ratios, and the median absolute deviation from the median. In 2015 part D PUF, oral anticoagulant claims have climbed to approximately 24.4 million with a payment cost of approximately $3.3 billion. DOAC claims comprised 31.0% of oral anticoagulant claims, showing a relative increase of approximately 127% compared to 2013. The upper decile of prescribers accounted for half of the oral anticoagulant prescriptions and the resulting cost. The median cost per DOAC claim in 2015 was $367.4 (interquartile range 323.9 to 445.9), as opposed to $12.3 (interquartile range 9.2 to 16.5) for warfarin. The median cost per standardized (30-day supply) prescription was $317.0 (interquartile range 303.8 to 324.3) and $8.0 (6.7 to 9.8) for DOACs and warfarin, respectively. DOAC adoption differs by specialty. Cardiologists, cardiac electrophysiologists and orthopedics had the highest predicted DOAC share per 100 claims (53.8, 72.9 and 71.5, respectively in 2015); nephrologists, family practitioners and geriatricians the lowest (22.3, 21.5 and 20.7, respectively in 2015). The p90/p10 ratio and the median absolute deviation from the median varied across HRRs and correlated positively with the prevalence of stroke and atrial fibrillation in the Medicare population. DOACs have been increasing their share year-over-year, but adoption varies across specialties. In prevalent areas for stroke and atrial fibrillation, prescription dispersion magnifies, and this may signify a rapid adoption by top providers.
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影响因子：
158.5
作者：
Cohen, Alexander T.;Harrington, Robert A.;Zakai, N.
通讯作者：
Zakai, N.
DOI：
10.1016/j.amjmed.2015.05.044
发表时间：
2015-12
期刊：
The American journal of medicine
影响因子：
--
作者：
Barnes GD;Lucas E;Alexander GC;Goldberger ZD
通讯作者：
Goldberger ZD
影响因子：
5.9
作者：
Desai, Nihar R.;Krumme, Alexis A.;Choudhry, Niteesh K.
通讯作者：
Choudhry, Niteesh K.
DOI：
10.1182/asheducation-2013.1.464
发表时间：
2013-12-01
影响因子：
3
作者：
Bauer, Kenneth A.
通讯作者：
Bauer, Kenneth A.
影响因子：
3.6
作者：
Sterne, Jonathan A. C.;Bodalia, Pritesh N.;Hingorani, Aroon D.
通讯作者：
Hingorani, Aroon D.