A Medicare database review found that physician preferences increasingly outweighed patient characteristics as determinants of first-time prescriptions for COX-2 inhibitors
A Medicare database review found that physician preferences increasingly outweighed patient characteristics as determinants of first-time prescriptions for COX-2 inhibitors
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DOI：
10.1016/j.jclinepi.2004.06.002
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发表时间：
2005-01-01
影响因子：
7.2
通讯作者：
Solomon, DH
中科院分区：
文献类型：
--
作者：
Schneeweiss, S;Glynn, RJ;Solomon, DH
目的：尽管创新药物可能被一些医生开得太少，但在上市后迅速采用可能会导致在没有明确适应症的情况下给患者开出此类药物。我们试图量化患者和医生因素对决定在环氧合酶-2(COX-2)抑制剂上市的前两年开出选择性环氧合酶-2(COX-2)抑制剂的相对贡献。方法：确定了宾夕法尼亚州老年药物援助合同中登记的37,957名联邦医疗保险受益人。所有患者都在1999年1月1日至2000年12月31日期间开始使用非选择性非类固醇抗炎药(NSAIDs)或选择性COX-2抑制剂，并且没有使用过NSAID。所有患者都有完整的处方药覆盖，包括非类固醇抗炎药和选择性COX-2抑制剂。随后的处方不被考虑。我们量化了首次服用COX-2的变异量，这些变异量可以由胃肠道(GI)毒性的预测因素、其他患者特征或医生偏好来解释。用非条件Logistic回归和随机截距混合效应Logistic回归分别对8个连续3个月的数据进行拟合，计算解释变异为R-2(标准化范围为0~1)。结果：COX-2抑制剂上市后180天内，55%的医生将其作为首选的非甾体抗炎药。在新的NSAID使用者中，COX-2处方依赖于医生的处方偏好(R-2=60%)是对胃肠道毒性(R-2=3%)和其他患者因素(R-2=30%)组合预测因子的两倍。在24个月的时间里，医生偏好解释的COX-2处方与患者因素的贡献之比从2上升到10以上。结论：第一季度首次使用COX-2抑制剂的处方在一定程度上依赖于患者因素，但在接下来的2年里，医生偏好的比例显著增加，这引发了为什么医生因素而不是患者危险因素影响COX-2抑制剂处方的问题。(C)2005 Elsevier Inc.保留所有权利。
Objective: Although innovative drugs may be underprescribed by some physicians, it is possible that rapid adoption after market introduction may lead to prescribing such drugs to patients without a clear indication. We sought to quantify the relative contributions of patient vs. physician factors to the decision to prescribe selective cyclooxygenase-2 (COX-2) inhibitors during the first 2 years of their availability.Methods: A cohort of 37,957 Medicare beneficiaries who were enrolled in the Pharmaceutical Assistance Contract for the Elderly in Pennsylvania was identified. All patients had started using nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) or selective COX-2 inhibitors between January 1, 1999, and December 31, 2000, and had no prior NSAID use. All had full prescription drug coverage, including NSAIDs and selective COX-2 inhibitors. Subsequent prescriptions were not considered. We quantified the amount of variation in first-time COX-2 prescribing that could be explained by predictors of gastrointestinal (GI) toxicity, other patient characteristics, or physician preferences. Explained variation was calculated as the R-2 (standardized to range from 0 to 1) from unconditional logistic regression and random intercept mixed effects logistic regression, fitted separately in each of eight consecutive 3-month periods.Results: COX-2 inhibitors were adopted as the preferred NSAID by 55% of physicians within 180 days after they were marketed. In new NSAID users, COX-2 prescribing was twice as dependent on physician prescribing preferences (R-2 = 60%) as on the combined predictors of GI toxicity (R-2 = 3%) and other patient factors (R-2 = 30%). The ratio of COX-2 prescribing explained by physician preferences over the contribution of patient factors increased from 2 to more than 10 over a 24-month period.Conclusions: First-time COX-2 inhibitor prescribing was somewhat dependent on patient factors in the first quarter of marketing, but the proportional influence of physician preferences increased substantially over the following 2 years, raising the question of why physician factors and not patient risk factors influence COX-2 inhibitor prescribing. (C) 2005 Elsevier Inc. All rights reserved.