Php114 Deriving Doctors' Prescribing Patterns From Health Care Claims: An Instrumental Variable Analysis

Başer, Onur; Wang, L; Xie, Lin; Dysinger, A; Gust, C; Yüce, Hüseyin; Baser, E.

doi:10.1016/s1098-3015(11)72778-4

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“…Physician preference for therapeutic class was the most important determinant in initiating treatment with TNF antagonists compared with the alternative: prescribing synthetic antirheumatic drugs 1 and in other treatment situations. 3 4 35 Physician preference for an individual TNF antagonist was studied by Kamal et al . 36 In response to mailed questionnaires, most American rheumatologists said they preferred etanercept over adalimumab or infliximab and considered etanercept the most efficacious of the three drugs with less harm.…”

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confidence: 99%

Prescriber preference for a particular tumour necrosis factor antagonist drug and treatment discontinuation: population-based cohort

et al. 2014

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ObjectiveTo assess the effect of physician preference for a particular tumour necrosis factor α (TNF) antagonist on the risk of treatment discontinuation in rheumatoid arthritis.DesignPopulation-based cohort study.SettingBritish Columbia administrative health data (inpatients, outpatients and pharmacy).Participants2742 British Columbia residents who initiated a first course of a TNF antagonist between 2001 and December 2008, had been diagnosed with rheumatoid arthritis, and were treated by 1 of 58 medium-volume to high-volume prescribers.Independent variableA level of physician preference for the drug (higher or lower) was assigned based on preceding prescribing records of the care-providing physician. Higher preference was defined as at least 60% of TNF antagonist courses initiated in the preceding year. Sensitivity analysis was conducted with different thresholds for higher preference.Main outcome measureDrug discontinuation was defined as a drug-free interval of 180 days or switching to another TNF antagonist, anakinra, rituximab or abatacept. The risk of discontinuation was compared between different levels of physician preference using survival analysis.ResultsHigher preference for the prescribed TNF antagonist was associated with improved persistence with the drug (4.28 years (95% CI 3.70 to 4.90) vs 3.27 (2.84 to 3.84), with log rank test p value of 0.017). The adjusted HR for discontinuation was significantly lower in courses of drugs with higher preference (0.85 (0.76 to 0.96)). The results were robust in a sensitivity analysis.ConclusionsHigher physician preference was associated with decreased risk of discontinuing TNF antagonists in patients with rheumatoid arthritis. This finding suggests that physicians who strongly prefer a specific treatment help their patients to stay on treatment for a longer duration. Similar research on other treatments is warranted.

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