Evaluating equality in prescribing Novel Oral Anticoagulants (NOACs) in England: the protocol of a Bayesian small area analysis

Rezaei-Darzi, Ehsan, Mehdipour, Parinaz, Di Cesare, Mariachiara ORCID: https://orcid.org/0000-0002-3934-3364, Farzadfar, Farshad, Rahimzadeh, Shadi ORCID: https://orcid.org/0000-0002-0396-0803, Nissen, Lisa and Ahmadvand, Alireza (2021) Evaluating equality in prescribing Novel Oral Anticoagulants (NOACs) in England: the protocol of a Bayesian small area analysis. PLoS One, 16 (2) , e0246253. pp. 1-14. ISSN 1932-6203 [Article] (doi:10.1371/journal.pone.0246253)

Preview

PDF - Published version (with publisher's formatting) Available under License Creative Commons Attribution 4.0. Download (841kB) | Preview

Abstract

Background
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting about 1.6% of the population in England. Novel oral anticoagulants (NOACs) are approved AF treatments that reduce stroke risk. In this study, we estimate the equality in individual NOAC prescriptions with high spatial resolution in Clinical Commissioning Groups (CCGs) across England from 2014 to 2019.
Methods
A Bayesian spatio-temporal model will be used to estimate and predict the individual NOAC prescription trend on ‘prescription data’ as an indicator of health services utilisation, using a small area analysis methodology. The main dataset in this study is the “Practice Level Prescribing in England,” which contains four individual NOACs prescribed by all registered GP practices in England. We will use the defined daily dose (DDD) equivalent methodology, as recommended by the World Health Organization (WHO), to compare across space and time. Four licensed NOACs datasets will be summed per 1,000 patients at the CCG-level over time. We will also adjust for CCG-level covariates, such as demographic data, Multiple Deprivation Index, and rural-urban classification. We aim to employ the extended BYM2 model (space-time model) using the RStan package.
Discussion
This study suggests a new statistical modelling approach to link prescription and socioeconomic data to model pharmacoepidemiologic data. Quantifying space and time differences will allow for the evaluation of inequalities in the prescription of NOACs. The methodology will help develop geographically targeted public health interventions, campaigns, audits, or guidelines to improve areas of low prescription. This approach can be used for other medications, especially those used for chronic diseases that must be monitored over time.

Actions (login required)

View Item

Statistics

DownloadsShow export options

Export as CSVXMLJSON

Activity Overview

6 month trend

48Downloads

6 month trend

65Hits

Additional statistics are available via IRStats2.