Key result
Coverage of ticagrelor by a publicly funded medication plan was associated with an 11.4% increase in the utilization of all available P2Y12 inhibitors within the first month among PCI patients.
Why the study?
Guidelines recommend acetylsalicylic acid and ticagrelor following ACS, but appropriate prescription practices lag.
Do provincial and national implementation strategies, including guideline updates and publicly funded drug coverage, improve P2Y12 inhibitor utilization in elderly patients following acute coronary syndrome?
Observational (n=114,142)
Do provincial and national implementation strategies, including guideline updates and publicly funded drug coverage, improve P2Y12 inhibitor utilization in elderly patients following acute coronary syndrome?
Answers are grounded in this paper and cite their sources.
Policy changes, particularly drug coverage by a publicly funded model, were essential for the uptake of guideline-recommended P2Y12 inhibitors in elderly patients following acute coronary syndrome.
BACKGROUND: Guidelines recommend both acetylsalicylic acid and ticagrelor following acute coronary syndrome (ACS), but appropriate prescription practices lag. We analyzed the impact of government medication approval, national guideline updates, and publicly funded drug coverage plans on P2Y12 inhibitor utilization. METHODS: Accessing provincial databases, we obtained data for elderly ACS patients in Ontario, Canada, between 2008 and 2018. Using interrupted-time series with descriptive statistics and segmented regression analysis, we evaluated types of P2Y12 inhibitors prescribed at discharge and changes to their utilization in patients managed with percutaneous intervention (PCI), coronary artery bypass grafting (CABG) or medically, following national antiplatelet therapy guidelines (by the Canadian Cardiovascular Society), ticagrelor's national approval by Health Canada, and ticagrelor's coverage by a publicly funded medication plan. RESULTS: We included 114,142 patients (49.4%-PCI; mean age 75.71±6.94 and 62.3% male and 7.7%-CABG; mean age 74.11±5.63 and 73.5% male). Among PCI patients, clopidogrel utilization declined monthly after 2010 national guidelines were published (p<0.0001) and within the first month after ticagrelor's national approval by Health Canada (p=0.03). Among PCI patients, ticagrelor utilization increased within the first month (p<0.0001) and continued increasing monthly (p<0.0001) after its coverage by a publicly funded medication plan. Among PCI patients, clopidogrel utilization declined within the first month (p=0.003) and ticagrelor utilization increased monthly (p=0.05) after 2012 CCS guidelines. Among CABG patients, ticagrelor's coverage was associated with a monthly increase in its utilization (p<0.0001). CONCLUSION: National guideline updates and drug coverage by a publicly funded medication plan significantly improved P2Y12 inhibitor utilization. Barriers to appropriate antiplatelet therapy in the surgical population must be explored.
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Gupta et al. (2021) conducted an observational in Acute coronary syndrome (n=114,142). Publicly funded medication plan coverage and national guideline updates vs. Pre-implementation period was evaluated on Change in utilization of all available P2Y12 inhibitors within the first month after publicly funded medication plan coverage (PCI patients) (11.4% increase, p=<0.0001). Coverage of ticagrelor by a publicly funded medication plan was associated with an 11.4% increase in the utilization of all available P2Y12 inhibitors within the first month among PCI patients.
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