RetroSearch Browse

Home - News ( United States | United Kingdom | Italy | Germany ) - Football scores

Showing content from https://pubmed.ncbi.nlm.nih.gov/26914450/ below:

The Influence of Socioeconomic Status on Selection of Anticoagulation for Atrial Fibrillation

. 2016 Feb 25;11(2):e0149142. doi: 10.1371/journal.pone.0149142. eCollection 2016. The Influence of Socioeconomic Status on Selection of Anticoagulation for Atrial Fibrillation

Affiliations

¹ Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
² Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada.
⁴ Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
⁵ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
⁶ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
⁷ Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁸ Clinical Pharmacology and Toxicology, Sunnybrook Research Institute, Toronto, Ontario, Canada.

PMID: 26914450
PMCID: PMC4767939
DOI: 10.1371/journal.pone.0149142

Item in Clipboard

The Influence of Socioeconomic Status on Selection of Anticoagulation for Atrial Fibrillation

Michelle Sholzberg et al. PLoS One. 2016.

. 2016 Feb 25;11(2):e0149142. doi: 10.1371/journal.pone.0149142. eCollection 2016. Affiliations

¹ Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
² Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada.
⁴ Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
⁵ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
⁶ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
⁷ Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁸ Clinical Pharmacology and Toxicology, Sunnybrook Research Institute, Toronto, Ontario, Canada.

PMID: 26914450
PMCID: PMC4767939
DOI: 10.1371/journal.pone.0149142

Item in Clipboard

Abstract

Importance: Without third-party insurance, access to marketed drugs is limited to those who can afford to pay. We examined this phenomenon in the context of anticoagulation for patients with nonvalvular atrial fibrillation (NVAF).

Objective: To determine whether, among older Ontarians receiving anticoagulation for NVAF, patients of higher socioeconomic status (SES) were more likely to switch from warfarin to dabigatran prior to its addition to the provincial formulary.

Design, setting and participants: Population-based retrospective cohort study of Ontarians aged 66 years and older, between 2008 and 2012.

Exposure: Socioeconomic status, as approximated by median neighborhood income.

Main outcomes and measure: We identified two groups of older adults with nonvalvular atrial fibrillation: those who appeared to switch from warfarin to dabigatran after its market approval but prior to its inclusion on the provincial formulary ("switchers"), and those with ongoing warfarin use during the same interval ("non-switchers").

Results: We studied 34,797 patients, including 3183 "switchers" and 31,614 "non-switchers". We found that higher SES was associated with switching to dabigatran prior to its coverage on the provincial formulary (p<0.0001). In multivariable analysis, subjects in the highest quintile were 50% more likely to switch to dabigatran than those in the lowest income quintile (11.3% vs. 7.3%; adjusted odds ratio 1.50; 95% CI 1.32 to 1.68). Following dabigatran's addition to the formulary, the income gradient disappeared.

Conclusions and relevance: We documented socioeconomic inequality in access to dabigatran among patients receiving warfarin for NVAF. This disparity was eliminated following the drug's addition to the provincial formulary, highlighting the importance of timely reimbursement decisions.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures
Fig 1. Study Design.

Legend: ¹ Patient…

Fig 1. Study Design.

Legend: ¹ Patient with Non-Valvular Atrial Fibrillation on warfarin over the…

Fig 1. Study Design.

Legend: ¹ Patient with Non-Valvular Atrial Fibrillation on warfarin over the age of 66 years.² Non-switchers are those with ≥ 2 warfarin prescriptions in the 6 months prior to dabigatran being listed on the public formulary. ³ Switchers are those with NO warfarin prescriptions in the 6 months prior to dabigatran being listed on the public formulary.