| Popis: |
Background: Blood thinners such as warfarin have been a healthcare staple in treating stroke (and stroke prevention), atrial fibrillation, and venous thromboembolism. In recent years, Factor Xa inhibitors such as apixaban and rivaroxaban have been replacing warfarin prescribing. Warfarin is an excellent baseline medication due to its generally low price, common medication, and narrow therapeutic window. Apixaban and rivaroxaban have larger therapeutic windows and typically have standard dosing once a day or twice a day. Non-adherence to medication is an ongoing problem in healthcare. For the medicines of warfarin, apixaban, and rivaroxaban, being adherent is crucial. Medication adherence can be affected by the medication regimen, cost of the medication, and other healthcare costs. Warfarin is cheap, but constant visits to clinics, dose changes, and monitoring may cause patients not to be adherent. Apixaban and rivaroxaban have better regimens but can be very costly depending on insurances and copays. Socioeconomic factors such as race, gender, and income may also contribute to non-adherence to therapy; these factors can affect the quality of the patient’s life. Objective: The primary objective of this retrospective cohort analysis is to examine the use of the anticoagulants of warfarin, apixaban, and rivaroxaban regarding what could alter the patient’s adherence to the medications. The objective will have specific aims, including what socioeconomic factors could take part in the choice of medication, the differences in adherence to the medications through medication possession ratio (MPR), and if the medications can affect the total healthcare expenditures of the medications that are being evaluated. Methods: Datasets from the Medical Expenditure Panel Survey (MEPS) from 2016-2018 were used. The medications and the socioeconomic factors that may affect the medication of choice were evaluated through frequency and chi-square analysis for the categorical variables and a one-way ANOVA for the continuous variables. The adherence to the medications through the evaluation of MPR was done by creating a calculation for MPR and using a one-way ANOVA and using logistic regression to further evaluate the association to these factors for the adherence to the medication. Total healthcare expenditures descriptive values were evaluated through one-way ANOVA, and then a regression was performed to assess the association of the other variables to the expenditures. Results: The socioeconomic and sociodemographic factors such as race, gender, insurance coverage, and poverty level are associated with the choice of therapy that the patient has undertaken. Socioeconomic status is an area in research that has been gaining traction, and projects such as this one and the analysis performed are essential in determining these associations and trends. Medication adherence is essential for patients' health and well-being, but adherence is something that can be difficult to analyze. Adherence can be affected by instances such as the medication of choice, income level, education level, race, and some diagnostic conditions in terms of MPR and odds ratios. However, the adherence to the medication can be evaluated with equations such as MPR, and looking at the averages are helpful to gather intel on the medication adherence. The medications of warfarin, apixaban, and rivaroxaban have differences, and warfarin was found to have the most adherent patients in terms of MPR. The total healthcare expenditures are also associated with medication choice, which in turn can affect adherence to the medication; the sociodemographic factors of the individuals whose information was reported can also play a part in these associations.Conclusion: The socioeconomic variables of gender, poverty level, income, total healthcare expenditures, and insurance coverage were associated and strongly indicated to possibly have an effect on the choice of medication that is used for therapy. |
