Estimating the Impact of Adherence to Direct Oral Anticoagulants on Health Outcomes Among Patients with Atrial Fibrillation

dc.contributor.advisorAbughosh, Susan M.
dc.contributor.committeeMemberChen, Hua
dc.contributor.committeeMemberEssien, Ekere James
dc.contributor.committeeMemberWanat, Matthew A.
dc.contributor.committeeMemberDeshmukh, Ashish A.
dc.creatorMohan, Anjana
dc.creator.orcid0000-0002-1200-1153
dc.date.accessioned2023-01-01T23:15:08Z
dc.date.createdAugust 2022
dc.date.issued2022-08
dc.date.updated2023-01-01T23:15:09Z
dc.description.abstractSuboptimal adherence to direct oral anticoagulants (DOACs) among patients with atrial fibrillation can result in worsening clinical outcomes and increased mortality risk. A critical gap in evidence showed that studies did not (1) Evaluate the adherence to DOACs using group-based trajectory modeling (GBTM); (2) Used the traditional models to evaluate the association between adherence to DOACs and clinical outcomes without addressing the time-varying confounder affected by prior exposure; (3) No economic models have compared the cost-effectiveness of DOACs by incorporating adherence. This study was developed based on the evidence gap to address the shortcomings. The primary objective was to identify the adherence trajectories of DOAC adherence. The secondary objective was to evaluate the impact of adherence to DOACs on the composite events/bleeding events using a marginal structural model. Finally, this study compared the cost-effectiveness of apixaban and rivaroxaban by incorporating real-world evidence. The study was comprised of 1,969 patients with AF. The adherence to DOACs was suboptimal among Medicare Advantage Plan beneficiaries. Only 36.8% were adherent during the follow-up. Adherence to DOACs was not significantly associated with composite events/bleeding events. After incorporating adherence to the economic model, apixaban was a cost-effective alternative to rivaroxaban from a US payers' perspective. This study gives a piece of comprehensive information regarding the importance of being adherent over a longer period of time.
dc.description.departmentPharmaceutical Health Outcomes and Policy, Department of
dc.format.digitalOriginborn digital
dc.format.mimetypeapplication/pdf
dc.identifier.urihttps://hdl.handle.net/10657/13261
dc.language.isoeng
dc.rightsThe author of this work is the copyright owner. UH Libraries and the Texas Digital Library have their permission to store and provide access to this work. Further transmission, reproduction, or presentation of this work is prohibited except with permission of the author(s).
dc.subjectDirect oral anticoagulants
dc.subjectAtrial fibrillation
dc.subjectElderly
dc.subjectAdherence
dc.subjectComposite events
dc.subjectBleeding events
dc.subjectCost-effectiveness
dc.titleEstimating the Impact of Adherence to Direct Oral Anticoagulants on Health Outcomes Among Patients with Atrial Fibrillation
dc.type.dcmiText
dc.type.genreThesis
dcterms.accessRightsThe full text of this item is not available at this time because the student has placed this item under an embargo for a period of time. The Libraries are not authorized to provide a copy of this work during the embargo period.
local.embargo.lift2024-08-01
local.embargo.terms2024-08-01
thesis.degree.collegeCollege of Pharmacy
thesis.degree.departmentPharmaceutical Health Outcomes and Policy, Department of
thesis.degree.disciplinePharmaceutic Health Outcomes & Policy
thesis.degree.grantorUniversity of Houston
thesis.degree.levelDoctoral
thesis.degree.nameDoctor of Philosophy

Files

License bundle

Now showing 1 - 2 of 2
No Thumbnail Available
Name:
PROQUEST_LICENSE.txt
Size:
4.43 KB
Format:
Plain Text
Description:
No Thumbnail Available
Name:
LICENSE.txt
Size:
1.81 KB
Format:
Plain Text
Description: