Evaluating equality in prescribing Novel Oral Anticoagulants (NOACs) in England: The protocol of a Bayesian small area analysis
Open Access
- 4 February 2021
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 16 (2), e0246253
- https://doi.org/10.1371/journal.pone.0246253
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.This publication has 21 references indexed in Scilit:
- NOAC monitoring, reversal agents, and post-approval safety and effectiveness evaluation: A cardiac safety research consortium think tankAmerican Heart Journal, 2016
- Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosisNature Reviews Cardiology, 2016
- Geographical and socioeconomic inequalities in women and children's nutritional status in Pakistan in 2011: an analysis of data from a nationally representative surveyThe Lancet. Global Health, 2015
- Small-Area Spatiotemporal Analysis of Pedestrian and Bicyclist Injuries in New York CityEpidemiology, 2015
- Oral anticoagulation to reduce risk of stroke in patients with atrial fibrillation: current and future therapiesClinical Interventions in Aging, 2013
- Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation: NICE guidanceHeart, 2012
- A novel framework for validating and applying standardized small area measurement strategiesPopulation Health Metrics, 2010
- Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4The Lancet, 2010
- Bayesian and non-Bayesian approaches to statistical inference and decision-makingJournal of Computational and Applied Mathematics, 1995
- Bayesian image restoration, with two applications in spatial statisticsAnnals of the Institute of Statistical Mathematics, 1991