Table III:
Trends in adjusted rates of fenofibrate and dronedarone use before and after evidence introduction, by patient and provider characteristics
| Panel A: Concurrent fenofibrate and statin therapy | ||||||||
|---|---|---|---|---|---|---|---|---|
| Before | After | After-Before (Change in Trends) | After-Before (Change in Level) | |||||
| All patients in the cohort | 0.09 (0.07, 0.11) | −0.01 (−0.02, −0.01) | −0.10 (−0.12, −0.08) | 0.10 (0.03, 0.18) | ||||
|
Patient Characteristics | ||||||||
| Non-Hispanic White | 0.09 (0.07, 0.11) | −0.01 (−0.02, −0.00) | −0.10 (−0.13, −0.08) | 0.06 (−0.03, 0.16) | ||||
| Non-Hispanic Black | 0.06 (0.03, 0.08) | −0.01 (−0.02, −0.01) | −0.06 (−0.10, −0.03) | 0.03 (−0.11, 0.17) | ||||
| Diff. P-value | 0.054 | 0.38 | 0.05 | 0.69 | ||||
| Non-Hispanic White | 0.09 (0.07, 0.11) | −0.01 (−0.02, −0.00) | −0.10 (−0.13, −0.08) | 0.06 (−0.03, 0.16) | ||||
| Asian | 0.17 (0.10, 0.24) | −0.01 (−0.04, 0.02) | −0.18 (−0.26, −0.10) | 0.04 (−0.30, 0.38) | ||||
| Diff. P-value | 0.05 | 0.89 | 0.10 | 0.92 | ||||
| Non-Hispanic White | 0.09 (0.07, 0.11) | −0.01 (−0.02, −0.00) | −0.10 (−0.13, −0.08) | 0.10 (0.02, 0.17) | ||||
| Other non-Hispanic, non-white | 0.17 (0.04, 0.31) | −0.07 (−0.12, −0.01) | −0.24 (−0.39, −0.08) | −0.13 (−0.77, 0.52) | ||||
| Diff. P-value | 0.20 | 0.10 | 0.08 | 0.50 | ||||
| Non-Hispanic White | 0.09 (0.07, 0.11) | −0.01 (−0.02, −0.00) | −0.10 (−0.13, −0.08) | 0.06 (−0.03, 0.15) | ||||
| Hispanic | 0.11 (0.06, 0.16) | −0.01 (−0.04, 0.01) | −0.12 (−0.19, −0.06) | 0.31, (0.05, 0.57) | ||||
| Diff. P-value | 0.50 | 0.90 | 0.60 | 0.07 | ||||
| High socioeconomic status | 0.09 (0.07, 0.11) | −0.02 (−0.03, −0.01) | −0.11 (−0.14, −0.09) | 0.09 (−0.00, 0.18) | ||||
| Low socioeconomic status | 0.08 (0.05, 0.11) | 0.00 (−0.01, 0.02) | −0.08 (−0.11, −0.04) | 0.13 (−0.01, 0.27) | ||||
| Diff. P-value | 0.38 | 0.01 | 0.09 | 0.65 | ||||
| Non-Dual eligible patients | 0.08 (0.06, 0.10) | −0.01 (−0.01, 0.01) | −0.08 (−0.11, −0.06) | 0.09 (−0.01, 0.19) | ||||
| Dual eligible patients | 0.09 (0.06, 0.12) | −0.02 (−0.03, −0.01) | −0.11 (−0.15, −0.08) | 0.13 (0.00, 0.26) | ||||
| Diff. P-value | 0.43 | 0.04 | 0.14 | 0.61 | ||||
| Metropolitan | 0.09 (0.07, 0.11) | −0.02 (−0.03, −0.01) | −0.11 (−0.13, −0.08) | 0.10 (0.02, 0.19) | ||||
| Non-Metropolitan | 0.09 (0.05, 0.13) | −0.01 (−0.02, 0.01) | −0.09 (−0.14, −0.05) | 0.10 (−0.01, 0.27) | ||||
| Diff. P-value | 0.93 | 0.31 | 0.64 | 1.00 | ||||
|
Provider Characteristics | ||||||||
| Male provider | 0.09 (0.07, 0.11) | −0.01 (−0.02, 0.00) | −0.10 (−0.12, −0.08) | 0.09 (−0.00, 0.18) | ||||
| Female provider | 0.09 (0.05, 0.13) | −0.04 (−0.05, −0.02) | −0.12 (−0.17, −0.08) | 0.16 (−0.17, 0.33) | ||||
| Diff. P-value | 0.94 | 0.01 | 0.29 | 0.48 | ||||
| Provider under 65 | 0.10 (0.08, 0.12) | −0.01 (−0.02, −0.01) | −0.12 (−0.14, −0.09) | 0.07 (−0.02, 0.16) | ||||
| Provider 65 or over | 0.04 (0.01, 0.08) | −0.02 (−0.03, 0.00) | −0.06 (−0.10, −0.01) | 0.22 (0.05, 0.39) | ||||
| Diff. P-value | 0.003 | 0.89 | 0.02 | 0.15 | ||||
| Cardiologist | 0.00 (−0.11, 0.11) | −0.03 (−0.07, 0.01) | −0.03 (−0.15, 0.09) | 0.10 (−0.31, 0.51) | ||||
| Primary care provider | 0.10 (0.08, 0.12) | −0.02 (−0.03, −0.01) | −0.12 (−0.14, −0.09) | 0.10 (0.02, 0.19) | ||||
| Diff. P-value | 0.08 | 0.49 | 0.16 | 0.98 | ||||
| Endocrinologist | 0.23 (0.13, 0.32) | −0.06 (−0.11, −0.01) | −0.29 (−0.40, −0.18) | 0.21 (0.85, 2.65) | ||||
| Primary care provider | 0.10 (0.08, 0.12) | −0.02 (−0.03, −0.01) | −0.12 (−0.14, −0.09) | 0.10 (0.02, 0.19) | ||||
| Diff. P-value | 0.01 | 0.06 | 0.00 | 0.65 | ||||
| Other specialty types | 0.05 (−0.01, 0.10) | 0.02 (−0.01, 0.05) | −0.03 (−0.09, 0.04) | 0.02 (−0.26, 0.30) | ||||
| Primary care provider | 0.10 (0.08, 0.12) | −0.02 (−0.03, −0.01) | −0.12 (−0.14, −0.09) | 0.10 (0.02, 0.19) | ||||
| Diff. P-value | 0.09 | 0.01 | 0.02 | 0.60 | ||||
| Panel B: Dronedarone | ||||||||
| Before | After | After-Before (Change in Trends) | After-Before (Change in Level) | |||||
| All patients in the cohort | 0.47 (0.45, 0.49) | −0.13 (−0.15, −0.10) | −0.59 (−0.64, −0.55) | −1.64 (−1.80, −1.48) | ||||
|
Patient Characteristics | ||||||||
| Non-Hispanic White | 0.47 (0.45, 0.49) | −0.12 (−0.15, −0.09) | −0.59 (−0.63, −0.55) | −1.64 (−1.81, −1.48) | ||||
| Non-Hispanic Black | 0.43 (0.32, 0.54) | −0.20 (−0.33, −0.06) | −0.63 (−0.84, −0.42) | −1.33 (−2.14, −0.52) | ||||
| Diff. P-value | 0.51 | 0.27 | 0.72 | 0.46 | ||||
| Non-Hispanic White | 0.47 (0.45, 0.49) | −0.12 (−0.15, −0.09) | −0.59 (−0.63, −0.55) | −1.64 (−1.81, −1.48) | ||||
| Asian | 0.63 (0.43, 0.83) | −0.28 (−0.51, −0.06) | −0.91 (−1.29, −0.54) | −2.68 (−4.23, −1.14) | ||||
| Diff. P-value | 0.13 | 0.15 | 0.09 | 0.19 | ||||
| Non-Hispanic White | 0.47 (0.45, 0.49) | −0.12 (−0.15, −0.10) | −0.59 (−0.63, −0.55) | −1.64 (−1.79, −1.48) | ||||
| Other non-Hispanic, non-white | 0.55 (0.28, 0.83) | −0.25 (−0.54, 0.05) | −0.80 (−1.28, −0.33) | −2.24 (−4.43, −0.05) | ||||
| Diff. P-value | 0.55 | 0.41 | 0.39 | 0.59 | ||||
| Non-Hispanic White | 0.47 (0.45, 0.49) | −0.12 (−0.15, −0.09) | −0.59 (−0.63, −0.55) | −1.64 (−1.81, −1.48) | ||||
| Hispanic | 0.42 (0.31, 0.53) | −0.13 (−0.28, 0.01) | −0.55 (−0.77, −0.33) | −1.33 (−2.18, −0.48) | ||||
| Diff. P-value | 0.35 | 0.86 | 0.73 | 0.48 | ||||
| High socioeconomic status | 0.47 (0.45, 0.50) | −0.13 (−0.16, −0.10) | −0.60 (−0.65, −0.55) | −1.64 (−1.82, −1.47) | ||||
| Low socioeconomic status | 0.46 (0.42, 0.51) | −0.11 (−0.17, −0.05) | −0.58 (−0.67, −0.49) | −1.63 (−1.99, −1.26) | ||||
| Diff. P-value | 0.76 | 0.71 | 0.69 | 0.94 | ||||
| Non-Dual eligible patients | 0.51 (0.48, 0.54) | −0.15 (−0.18, −0.11) | −0.66 (−0.71, −0.61) | −1.69 (−1.88, −1.50) | ||||
| Dual-eligible patients | 0.36 (0.32, 0.39) | −0.08 (−0.12, −0.03) | −0.43 (−0.50, −0.36) | −1.49 (−1.77, −1.22) | ||||
| Diff. P-value | P<0.001 | 0.02 | P<0.001 | 0.25 | ||||
| Metropolitan | 0.47 (0.45, 0.50) | −0.12 (−0.16, −0.09) | −0.60 (−0.64, −0.55) | −1.62 (−0.12, −1.44) | ||||
| Non-Metropolitan | 0.46 (0.41, 0.50) | −0.13 (−0.18, −0.07) | −0.58 (−0.67, −0.49) | −1.73 (−2.07, −1.38) | ||||
| Diff. P-value | 0.49 | 0.98 | 0.74 | 0.59 | ||||
|
Provider Characteristics | ||||||||
| Male provider | 0.49 (0.46, 0.51) | −0.13 (−0.16, −0.10) | −0.62 (−0.66, −0.57) | −1.70 (−1.87, −1.52) | ||||
| Female provider | 0.38 (0.33, 0.43) | −0.10 (−0.17, −0.03) | −0.48 (−0.58, −0.38) | −1.31 (−1.69, −0.92) | ||||
| Diff. P-value | P<0.001 | 0.42 | 0.01 | 0.07 | ||||
| Provider under 65 | 0.49 (0.46, 0.51) | −0.13 (−0.16, −0.10) | −0.61 (−0.66, −0.57) | −1.73 (−1.91, −1.54) | ||||
| Provider 65 or over | 0.40 (0.36, 0.45) | −0.13 (−0.18, −0.06) | −0.53 (−0.62, −0.44) | −1.29 (−1.64, −0.95) | ||||
| Diff. P-value | 0.001 | 0.97 | 0.10 | 0.03 | ||||
| Cardiologist | 0.70 (0.66, 0.73) | −0.19 (−0.24, −0.15) | −0.89 (−0.96, −0.82) | −2.47 (−2.77, −2.18) | ||||
| Primary care provider | 0.28 (0.25, 0.30) | −0.06 (−0.09, −0.03) | −0.34 (−0.38, −0.29) | −0.94 (−1.12, −0.76) | ||||
| Diff. P-value | P<0.001 | P<0.001 | P<0.001 | P<0.001 | ||||
| Other specialty types | 0.26 (0.19, 0.33) | −0.09 (−0.18, −0.01) | −0.35 (−0.48, −0.21) | −0.83 (−1.44, −0.22) | ||||
| Primary care provider | 0.28 (0.25, 0.30) | −0.06 (−0.09, −0.03) | −0.34 (−0.38, −0.29) | −0.94 (−1.12, −0.76) | ||||
| Diff. P-value | 0.68 | 0.61 | 0.89 | 0.73 | ||||
Notes: Estimates represent linear time trends in the proportion of patient-quarters in the diabetes/permanent AF cohorts using fenofibrates/dronedarone. 95% confidence intervals reported in parentheses. Models adjusted for patient characteristics (race/ethnicity, SES, rurality, age, sex, and Charlson comorbidity index) and provider characteristics (provider age, sex, and specialty). All models were estimated using multivariate linear regression. The “Diff. P-value” rows provide p-values for a test that the time trends or level differences are different for the two patient subgroups. For Panel A, “Before” refers to Q1 2008-Q1 2009, prior to evidence from the ACCORD trial on April 29, 2010 declaring fenofibrate-statin combination therapy to be ineffective, and “After” refers to Q2 2010-Q4 2013. For Panel B, “Before” refers to Q1 2009-Q3 2011, prior to evidence from the PALLAS trial on November 14, 2011 declaring dronedarone to be unsafe, and “After” refers to Q4 2012-Q4 2013.