Impact of Delayed Adoption of Novel Atrial Fibrillation Treatments

• Published in: The American journal of managed care 2024-12
• Main Author: Kim, Jaehong
• Format: Article
• Language: English
• Subjects: Anticoagulants; Cardiac arrhythmia; Case studies; Codes; Cohort analysis; Cost control; Cross-sectional studies; Disease; Expenditures; Geography; Health maintenance organizations; Health services utilization; HMOs; Ischemia; Medicare; Mortality; Patients; Stroke; Variables
• ISSN: 1088-0224; 1936-2692

From the insurer's perspective, new treatment introduction requires a process of coverage decision-making, decisions on access restrictions such as prior authorization and step edits, decisions on co-pays and updates to coding/billing systems, and time needed for medical societies to update clinical guidelines.5,6 Lack of physician awareness of new treatments also could contribute to adoption delays.7,8 Finally, physicians' persistence in treatment choice due to familiarity and experience could delay new treatments from becoming broadly adopted by patients.9 However, previous research has shown that treatment delays worsen health outcomes for certain diseases (eg, cystic fibrosis, cancer).10,11 Against this backdrop, this study explored the clinical and economic impacts of adoption delays in novel medical treatment using direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) as a case study. [...]the impact of DOAC adoption rates on ischemic stroke outcomes in MSA- and individual-level regression analyses were evaluated. [...]we extrapolated regression results to identify the hypothetical impact of patients moving from a geographic region with slow (10th percentile) to rapid (90th percentile) DOAC adoption. Demographic control variables included patient age, sex, and insurance type (commercial health maintenance organization, preferred provider organization, point-of-service, or fee-for-service vs Medicare Advantage).