My Papers

AMCP Abstract Winners

Next month in San Diego, the Academy of Managed Care Pharmacy is holding its annual conference.  I am a co-author on two abstracts accepted as part of the conference.  The first abstract won a platinum medal as one of the top 7 abstracts in the entire conference, the second abstract won a silver medal as well. The titles are below and so are the full abstracts.  I would like to thank all my co-authors for their hard work on these projects.

  • Platinum Medal: “Physician and Patient Preferences for Nonvalvular Atrial Fibrillation Therapies”
  • Silver Medical: “Regional Variation in Rheumatoid Arthritis Quality Measures”

FULL ABSTRACTS

Physician and Patient Preferences for Nonvalvular Atrial Fibrillation Therapies
Bruno A, Shafrin J, MacEwan J, Campinha-Bacote A, Trocio J, Shah M, Romley J, Tan W.

BACKGROUND: Patients with nonvalvular atrial fibrillation (NVAF) are at increased risk for stroke. To reduce stroke risk, physician and patients can choose from both standard anticoagulants (e.g., warfarin)
as well as novel oral anticoagulants (NOACs; e.g., apixaban, dabigatran, and rivaroxaban) that are associated with relative advantages and disadvantages.
OBJECTIVE: Compare patient and physician preferences for different antithrombotic therapies used to treat NVAF.
METHODS: Patients diagnosed with NVAF and physicians treating such patients were invited to complete an online survey. In addition to demographics and medical history questions (patients) and questions
on prescribing preferences and specialty (physicians), respondents completed 12 discrete choice experiment questions comparing two hypothetical NVAF therapies across five attributes: stroke risk, major
bleeding risk, convenience (regular blood-testing/dietary requirements), dosing frequency and patient out-of-pocket cost. A logistic regression was used to separately model physician and patient preferences,
and estimate willingness to pay (WTP) for each attribute. Market shares of actual therapies were calculated as the proportion of patients and physicians choosing treatments based on each therapy’s attributes.
RESULTS: Among the 200 physicians recruited, physicians were willing to pay $38 (95% CI: $22-$54) in patient monthly out-of-pocket cost for a 1% (absolute) decrease in stroke risk, $14 ($8-$21) for a 1%
decrease in major bleeding risk, $34 ($9-$60) for convenience, and $17 ($0-$34) for once-per-day dosing instead of twice per day. The corresponding WTP for the 201 patients recruited was $30 ($18-$42)
for reduced stroke risk, $16 ($9-$24) for reduced bleeding risk, -$52 (-$96- -$6) for convenience, and $9 (-$6-$24) for less frequent dosing. Antithrombotic market share distribution based on physician preferences was 34% apixaban, 20% dabigatran, 28% rivaroxaban, and 18% warfarin, compared to 16% apixaban, 9% dabigatran and 10% rivaroxaban, and 65% warfarin based on patient preferences.
CONCLUSIONS: Physicians preferred NOACs to warfarin due to avoidance of INR testing, but patients similarly preferred warfarin to NOACs due to an apparent preference for regular blood-testing/dietary
restrictions. Among NOACs, both physicians and patients preferred apixaban. The significant patient preference for regular blood-testing/dietary restrictions that is out of proportion to the other parameters need to be further understood.
SPONSORSHIP: This research was funded by Bristol-Myers Squibb and Pfizer.

Regional Variation in Rheumatoid Arthritis Quality Measures
Shafrin J, Ganguli A, Sanchez Y, Shim J, Seabury S.

BACKGROUND: Rheumatoid arthritis (RA) is an inflammatory disorder of the joints affecting 1.5 million patients in the U.S. In recent years, measures have been developed to monitor the quality of RA care offered by health plans and providers. For example, CMS incorporates a RA quality metric to the star ratings of Medicare Advantage (MA) plans. Despite these efforts, it is unclear whether the quality of care RA patients receive depends on where the patients live.
OBJECTIVE: Assess the geographic differences in the quality of RA care in the U.S.
METHODS: We used a large commercial claims database from July 2008 to June 2013 to measure quality of RA care across metropolitan statistical areas (MSAs), in terms of: (a) the share of RA patients prescribed a disease-modifying antirheumatic drug (DMARD), and (b) the share of patients screened for tuberculosis (TB) during the 6 months prior to initiating biologic DMARD therapy. Additional metrics examined were: RA prevalence, defined as the share of the population with RA, and the share of RA patients visiting a rheumatologist annually. Using logistic regression adjusting for age and gender and applying population weights, we measured average quality metric by MSA. We assessed geographic variation using standard deviation (SD) and interquartile range (IQR). The MA star rating for DMARD use was employed for benchmarking.
RESULTS: There were 381,488 patients who met the inclusion criteria. In the average MSA, 64.8% (SD: 11.2%, IQR: 59-72%) of RA patients received a DMARD, and 40.3% (SD: 6.5%, IQR: 36%-45%) of RA patients were screened for TB prior to initiating a biologic DMARD. RA prevalence was 0.63% (SD: 0.19%, IQR: 0.50-0.72%), and 49.7% (SD: 17.0%, IQR: 39-62%) of RA patients visited a rheumatologist annually. Based on these results, 9.4% of MSAs would qualify as 4 or 5 stars based on CMS’s “RA Management” quality metric. Compared to low quality regions (i.e. 1, 2 or 3 stars), high quality regions (i.e., 4 or 5 stars) had fewer Medicaid-eligible residents (20.3% vs. 18.4%, P = -0.20, P < 0.01) and more university-educated residents (25.3% vs. 27.2%, P = 0.26, P < 0.01).
CONCLUSIONS: Quality of care for R A patients varies across the U.S. based on IQR. Further, fewer than one in ten MSAs would be considered high quality based on CMS’s star ratings. Initiatives to promote uniformity in quality of care could improve outcomes for RA patients, particularly in areas where a large share of patients are Medicaid-eligible or have limited education.
SPONSORSHIP: This research was funded by AbbVie.

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