Elias J Dayoub1,2, Matthew Seigerman1, Sony Tuteja1, Taisei Kobayashi3,4,5, Daniel M Kolansky3, Jay Giri3,4,5, Peter W Groeneveld1,2,4,5. 1. Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia. 2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia. 3. Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia. 4. Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia. 5. Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Abstract
Importance: Current guidelines recommend prasugrel hydrochloride and ticagrelor hydrochloride as preferred therapies for patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). However, it is not well known how frequently these newer agents are being used in clinical practice or how adherence varies among the platelet adenosine diphosphate P2Y12 receptor (P2Y12) inhibitors. Objectives: To determine trends in use of the different P2Y12 inhibitors in patients who underwent PCI from 2008 to 2016 in a large cohort of commercially insured patients and differences in patient adherence and costs among the P2Y12 inhibitors. Design, Setting, and Participants: A retrospective cohort study used administrative claims from a large US national insurer (ie, UnitedHealthcare) from January 1, 2008, to December 1, 2016, comprising patients aged 18 to 64 years hospitalized for PCI who had not received a P2Y12 inhibitor for 90 days preceding PCI. The P2Y12 inhibitor filled within 30 days of discharge was identified from pharmacy claims. Main Outcomes and Measures: Proportion of patients filling prescriptions for P2Y12 inhibitors within 30 days of discharge by year, as well as medication possession ratios (MPRs) and total P2Y12 inhibitor copayments at 6 and 12 months for patients who received drug-eluting stents. Results: A total of 55 340 patients (12 754 [23.0%] women; mean [SD] age, 54.4 [7.1] years) who underwent PCI were included in this study. In 2008, 7667 (93.6%) patients filled a prescription for clopidogrel bisulfate and 521 (6.4%) filled no P2Y12 inhibitor prescription within 30 days of hospitalization. In 2016, 2406 (44.0%) patients filled clopidogrel prescriptions, 2015 (36.9%) filled either prasugrel or ticagrelor prescriptions, and 1045 (19.1%) patients filled no P2Y12 inhibitor prescription within 30 days of hospitalization. At 6 months, mean MPRs for patients who received a drug-eluting stent filling clopidogrel, prasugrel, and ticagrelor prescriptions were 0.85 (interquartile range [IQR], 0.82-1.00), 0.79 (IQR, 0.66-1.00), and 0.76 (IQR, 0.66-0.98) (P < .001), respectively; mean copayments for a 6 months' supply were $132 (IQR, $47-$203), $287 (IQR, $152-$389), and $265 (IQR, $53-$387) (P < .001), respectively. At 12 months, mean MPRs for clopidogrel, prasugrel, and ticagrelor were 0.76 (IQR, 0.58-0.99), 0.71 (IQR, 0.49-0.98), and 0.68 (IQR, 0.41-0.94) (P < .001), respectively; mean total copayments were $251 (IQR, $100-$371), $556 (IQR, $348-$730), and $557 (IQR, $233-$744) (P < .001), respectively. Conclusions and Relevance: Between 2008 and 2016, increased use of prasugrel and ticagrelor was accompanied by increased nonfilling of prescriptions for P2Y12 inhibitors within 30 days of discharge. Prasugrel and ticagrelor had higher patient costs and lower adherence in the year following PCI compared with clopidogrel. The introduction of newer, more expensive P2Y12 inhibitors was associated with lower adherence to these therapies.
Importance: Current guidelines recommend prasugrel hydrochloride and ticagrelor hydrochloride as preferred therapies for patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). However, it is not well known how frequently these newer agents are being used in clinical practice or how adherence varies among the platelet adenosine diphosphate P2Y12 receptor (P2Y12) inhibitors. Objectives: To determine trends in use of the different P2Y12 inhibitors in patients who underwent PCI from 2008 to 2016 in a large cohort of commercially insured patients and differences in patient adherence and costs among the P2Y12 inhibitors. Design, Setting, and Participants: A retrospective cohort study used administrative claims from a large US national insurer (ie, UnitedHealthcare) from January 1, 2008, to December 1, 2016, comprising patients aged 18 to 64 years hospitalized for PCI who had not received a P2Y12 inhibitor for 90 days preceding PCI. The P2Y12 inhibitor filled within 30 days of discharge was identified from pharmacy claims. Main Outcomes and Measures: Proportion of patients filling prescriptions for P2Y12 inhibitors within 30 days of discharge by year, as well as medication possession ratios (MPRs) and total P2Y12 inhibitor copayments at 6 and 12 months for patients who received drug-eluting stents. Results: A total of 55 340 patients (12 754 [23.0%] women; mean [SD] age, 54.4 [7.1] years) who underwent PCI were included in this study. In 2008, 7667 (93.6%) patients filled a prescription for clopidogrel bisulfate and 521 (6.4%) filled no P2Y12 inhibitor prescription within 30 days of hospitalization. In 2016, 2406 (44.0%) patients filled clopidogrel prescriptions, 2015 (36.9%) filled either prasugrel or ticagrelor prescriptions, and 1045 (19.1%) patients filled no P2Y12 inhibitor prescription within 30 days of hospitalization. At 6 months, mean MPRs for patients who received a drug-eluting stent filling clopidogrel, prasugrel, and ticagrelor prescriptions were 0.85 (interquartile range [IQR], 0.82-1.00), 0.79 (IQR, 0.66-1.00), and 0.76 (IQR, 0.66-0.98) (P < .001), respectively; mean copayments for a 6 months' supply were $132 (IQR, $47-$203), $287 (IQR, $152-$389), and $265 (IQR, $53-$387) (P < .001), respectively. At 12 months, mean MPRs for clopidogrel, prasugrel, and ticagrelor were 0.76 (IQR, 0.58-0.99), 0.71 (IQR, 0.49-0.98), and 0.68 (IQR, 0.41-0.94) (P < .001), respectively; mean total copayments were $251 (IQR, $100-$371), $556 (IQR, $348-$730), and $557 (IQR, $233-$744) (P < .001), respectively. Conclusions and Relevance: Between 2008 and 2016, increased use of prasugrel and ticagrelor was accompanied by increased nonfilling of prescriptions for P2Y12 inhibitors within 30 days of discharge. Prasugrel and ticagrelor had higher patient costs and lower adherence in the year following PCI compared with clopidogrel. The introduction of newer, more expensive P2Y12 inhibitors was associated with lower adherence to these therapies.
Authors: Marc P Bonaca; Deepak L Bhatt; Ton Oude Ophuis; P Gabriel Steg; Robert Storey; Marc Cohen; Julia Kuder; Kyungah Im; Giulia Magnani; Andrzej Budaj; Pierre Theroux; Christian Hamm; Jindrich Špinar; Robert G Kiss; Anthony J Dalby; Felix A Medina; Frederic Kontny; Philip E Aylward; Eva C Jensen; Peter Held; Eugene Braunwald; Marc S Sabatine Journal: JAMA Cardiol Date: 2016-07-01 Impact factor: 14.676
Authors: Cristina Varas-Lorenzo; Jordi Castellsague; Mary Rose Stang; Luis Tomas; Jaume Aguado; Susana Perez-Gutthann Journal: Pharmacoepidemiol Drug Saf Date: 2008-08 Impact factor: 2.890
Authors: Dimitrios Alexopoulos; John A Goudevenos; Ioanna Xanthopoulou; Spyridon Deftereos; George Sitafidis; Ioannis Kanakakis; Michalis Hamilos; Haralambos Parissis; Ioannis V Ntalas; Christos Angelidis; Stylianos Petousis; Manolis Vavuranakis; George Hahalis; Christodoulos Stefanadis Journal: Int J Cardiol Date: 2013-08-15 Impact factor: 4.164
Authors: Rachel M Black; Alexis K Williams; Lindsay Ratner; Daniel J Crona; Tim Wiltshire; Karen E Weck; George A Stouffer; Craig R Lee Journal: Pharmacogenomics Date: 2020-04-28 Impact factor: 2.533
Authors: Jared P Beller; William Z Chancellor; J Hunter Mehaffey; Robert B Hawkins; Matthew R Byler; Alan M Speir; Mohammed A Quader; Andy C Kiser; Leora T Yarboro; Gorav Ailawadi; Nicholas R Teman Journal: Ann Thorac Surg Date: 2020-02-11 Impact factor: 4.330
Authors: Elias J Dayoub; Ashwin S Nathan; Sameed Ahmed M Khatana; Matthew Seigerman; Sony Tuteja; Taisei Kobayashi; Daniel M Kolansky; Peter W Groeneveld; Jay Giri Journal: Circ Cardiovasc Interv Date: 2019-01 Impact factor: 6.546
Authors: Lauren Gilstrap; Jonathan S Skinner; Barbara Gladders; A James O'Malley; Amber E Barnato; Anna N A Tosteson; Andrea M Austin Journal: Circ Cardiovasc Qual Outcomes Date: 2020-03-09
Authors: Seng Chan You; Yeunsook Rho; Behnood Bikdeli; Jiwoo Kim; Anastasios Siapos; James Weaver; Ajit Londhe; Jaehyeong Cho; Jimyung Park; Martijn Schuemie; Marc A Suchard; David Madigan; George Hripcsak; Aakriti Gupta; Christian G Reich; Patrick B Ryan; Rae Woong Park; Harlan M Krumholz Journal: JAMA Date: 2020-10-27 Impact factor: 56.272
Authors: Naveen L Pereira; Michael E Farkouh; Derek So; Ryan Lennon; Nancy Geller; Verghese Mathew; Malcolm Bell; Jang-Ho Bae; Myung Ho Jeong; Ivan Chavez; Paul Gordon; J Dawn Abbott; Charles Cagin; Linnea Baudhuin; Yi-Ping Fu; Shaun G Goodman; Ahmed Hasan; Erin Iturriaga; Amir Lerman; Mandeep Sidhu; Jean-Francois Tanguay; Liewei Wang; Richard Weinshilboum; Robert Welsh; Yves Rosenberg; Kent Bailey; Charanjit Rihal Journal: JAMA Date: 2020-08-25 Impact factor: 56.272
Authors: D A Sychev; O A Baturina; K B Mirzaev; E Rytkin; D V Ivashchenko; D A Andreev; K A Ryzhikova; E A Grishina; P O Bochkov; R V Shevchenko Journal: Pharmgenomics Pers Med Date: 2020-01-23
Authors: Craig R Lee; Cameron D Thomas; Amber L Beitelshees; Sony Tuteja; Philip E Empey; James C Lee; Nita A Limdi; Julio D Duarte; Todd C Skaar; Yiqing Chen; Kelsey J Cook; James C Coons; Chrisly Dillon; Francesco Franchi; Jay Giri; Yan Gong; Rolf P Kreutz; Caitrin W McDonough; James M Stevenson; Karen E Weck; Dominick J Angiolillo; Julie A Johnson; George A Stouffer; Larisa H Cavallari Journal: Clin Pharmacol Ther Date: 2020-10-02 Impact factor: 6.875