Timothy S Anderson1, Wei-Hsuan Lo-Ciganic2, Walid F Gellad3, Rouxin Zhang4, Haiden A Huskamp5, Niteesh K Choudhry6, Chung-Chou H Chang7, Seth Richards-Shubik8, Hasan Guclu9, Bobby Jones10, Julie M Donohue11. 1. Division of General Internal Medicine, University of California, San Francisco, USA. 2. Department of Pharmacy, Practice and Science, College of Pharmacy University of Arizona, USA. 3. Division of General Internal Medicine at University of Pittsburgh School of Medicine; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, USA. 4. Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Crabtree Hall A613, Pittsburgh, PA 15261, USA. 5. Department of Health Care Policy, Harvard Medical School, USA. 6. Division of Pharmacoepidemiology and Pharmacoeconomics and Center for Healthcare Deliver Sciences, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA. 7. Division of General Internal Medicine at University of Pittsburgh School of Medicine, USA. 8. College of Business and Economics, Lehigh University, USA. 9. Department of Statistics, School of Engineering and Natural Sciences, Istanbul Medeniyet University, Istanbul, Turkey. 10. Department of Psychiatry, University of Pittsburgh Medical Center, USA. 11. Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Crabtree Hall A613, Pittsburgh, PA 15261, USA. Electronic address: jdonohue@pitt.edu.
Abstract
BACKGROUND: Little is known about physicians' approaches to adopting new cardiovascular drugs and how adoption varies between drugs of differing novelty. METHODS: Using data on dispensed prescriptions from IMS Health's Xponent™ database, we created a cohort of all primary care physicians (PCPs) and cardiologists in Pennsylvania who regularly prescribed anticoagulants, antihypertensives and statins from 2007 to 2011. We examined prescribing of three new cardiovascular drugs of differing novelty: dabigatran, aliskiren and pitavastatin. Outcomes were rapid adoption of each new drug, defined by early and sustained monthly prescribing detected by group-based trajectory models, by physicians within the first 15 months of marketplace introduction. RESULTS: 5953 physicians regularly prescribed each drug class. The majority of physicians (63.8%) adopted zero new drugs in the first 15 months, 35.0% rapidly adopted one or two, and 1.2% rapidly adopted all three. Physicians were more likely to rapidly adopt the most novel drug, dabigatran (27.3%), than aliskiren (10.5%) or pitavastatin (8.0%). Physician specialty and sex were the most consistent predictors of adoption. Compared to PCPs, cardiologists were more likely to rapidly adopt dabigatran (Adjusted Odds Ratio 8.90, 95% confidence interval 7.42-10.67; P<0.001) aliskerin (2.05, CI 1.56-2.69; P<0.001) and pitavastatin (3.44, CI 2.60-4.57; P<0.001). Female physicians were less likely to adopt dabigatran (0.71, CI 0.59-0.85; P <0.001) and aliskiren (0.64, CI 0.49-0.83; P <0.001). CONCLUSIONS: Physicians vary in their prescribing of recently-introduced cardiovascular drugs. Though most physicians did not rapidly adopt any new cardiovascular drugs, drug novelty and cardiology training were associated with greater adoption.
BACKGROUND: Little is known about physicians' approaches to adopting new cardiovascular drugs and how adoption varies between drugs of differing novelty. METHODS: Using data on dispensed prescriptions from IMS Health's Xponent™ database, we created a cohort of all primary care physicians (PCPs) and cardiologists in Pennsylvania who regularly prescribed anticoagulants, antihypertensives and statins from 2007 to 2011. We examined prescribing of three new cardiovascular drugs of differing novelty: dabigatran, aliskiren and pitavastatin. Outcomes were rapid adoption of each new drug, defined by early and sustained monthly prescribing detected by group-based trajectory models, by physicians within the first 15 months of marketplace introduction. RESULTS: 5953 physicians regularly prescribed each drug class. The majority of physicians (63.8%) adopted zero new drugs in the first 15 months, 35.0% rapidly adopted one or two, and 1.2% rapidly adopted all three. Physicians were more likely to rapidly adopt the most novel drug, dabigatran (27.3%), than aliskiren (10.5%) or pitavastatin (8.0%). Physician specialty and sex were the most consistent predictors of adoption. Compared to PCPs, cardiologists were more likely to rapidly adopt dabigatran (Adjusted Odds Ratio 8.90, 95% confidence interval 7.42-10.67; P<0.001) aliskerin (2.05, CI 1.56-2.69; P<0.001) and pitavastatin (3.44, CI 2.60-4.57; P<0.001). Female physicians were less likely to adopt dabigatran (0.71, CI 0.59-0.85; P <0.001) and aliskiren (0.64, CI 0.49-0.83; P <0.001). CONCLUSIONS: Physicians vary in their prescribing of recently-introduced cardiovascular drugs. Though most physicians did not rapidly adopt any new cardiovascular drugs, drug novelty and cardiology training were associated with greater adoption.
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