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Adherence to Non-VKA Oral Anticoagulant Medications Based on the Pharmacy Quality Alliance Measure.
Curr Med Res Opin. 2015 Sep 22;:1-16
Authors: McHorney CA, Crivera C, Laliberté F, Nelson WW, Germain G, Bookhart B, Martin S, Schein J, Lefebvre P, Deitelzweig S
Abstract
BACKGROUND: CMS Star Ratings help inform beneficiaries about the performance of health and drug plans. Medication adherence is currently weighted at nearly half of a Part D plan's Star Ratings. Including the adherence to non-VKA oral anticoagulant (NOACs) as a measure in the Star Ratings program may increase a plan's incentives to improve patient adherence.
OBJECTIVE: To assess the adherence to medication of patients who used the NOACs rivaroxaban, dabigatran, or apixaban in 2014 based on the Pharmacy Quality Alliance (PQA) adherence measure.
METHODS: Healthcare claims from the Humana database between 07/2013 and 12/2014 were analyzed. Adult patients with ≥2 dispensings of NOAC agents in 2014, at least 180 days apart between two NOAC dispensings in 2014, with >60 days of supply, and ≥180 days of continuous enrollment prior to the index NOAC were identified. PQA measure was calculated as the percentage of patients who had a proportion of days covered (PDC)≥0.8. Multivariate logistic regression analyses were also conducted adjusting for baseline confounders.
RESULTS: A total of 11,095 rivaroxaban, 6,548 dabigatran, and 3,532 apixaban users were identified. Based on the PQA adherence measure (PDC ≥0.8), a significantly higher proportion of rivaroxaban users (72.7%) was found to be adherent compared to dabigatran (67.2%: p<.001) and apixaban (69.5%: p<.001) users. Compared to apixaban users, the adjusted likelihood of being adherent was significantly higher for rivaroxaban users (unadjusted OR [95%CI]: 1.17 [1.08-1.27], p-value<.001; adjusted OR [95%CI]: 1.20 (1.01-1.31), p-value<.001) and significantly lower for dabigatran users (unadjusted OR [95%CI]: 0.90 [0.82-0.98], p-value=0.019; adjusted OR [95%CI]: 0.85 [0.77-0.93], p-value<.001).
LIMITATIONS: Claims data may have contained inaccuracies, possible change in patterns over time, and the impossibility to know if all supplied tablets were taken..
CONCLUSION: Using the PQA's adherence measure, rivaroxaban users were found to have a significantly higher adherence compared to apixaban and dabigatran users.
PMID: 26393483 [PubMed - as supplied by publisher]