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The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence
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| Veröffentlicht in: | Frontiers in pharmacology 10(2019) Artikel-Nummer 113, 7 Seiten |
|---|---|
| Personen und Körperschaften: | , , |
| Titel: | The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence/ Carmen Ruff, Ludmila Koukalova, Walter E. Haefeli and Andreas D. Meid |
| Format: | E-Book-Kapitel |
| Sprache: | Englisch |
| veröffentlicht: |
19 February 2019
|
| Gesamtaufnahme: |
: Frontiers in pharmacology, 10(2019) Artikel-Nummer 113, 7 Seiten
, volume:10 |
| Schlagwörter: | |
| Quelle: | Verbunddaten SWB Lizenzfreie Online-Ressourcen |
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| 245 | 1 | 4 | |a The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence |c Carmen Ruff, Ludmila Koukalova, Walter E. Haefeli and Andreas D. Meid |
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| 520 | |a Patients who do not sufficiently adhere to their dosing regimens will, ultimately, do not get the full benefit of their medication. For example, if direct oral anticoagulants (DOAC) are not taken continuously, an intervention to improve adherence or maintain persistence will show direct effects on clinical outcomes. Usually, adherent patients are defined by taking ≥ 80 % of their medication. The resulting binary adherence status from this threshold can as well be used for predictive classification. Thus, the threshold can determine the prediction model’s performance to identify patients at risk for poor adherence by this binary adherence status. In this perspective, we propose a plan for model development and performance considering the threshold’s role. Concerning development demands, we extracted predictors from a systematic literature search on DOAC adherence to be used as a core set of candidate predictors. Independently, we investigated how well a future model would technically have to perform by modeling drug intake and thromboembolic events based on a rivaroxaban pharmacokinetic-pharmacodynamic model. Using this simulation framework for different thresholds, we projected the impact of an imperfectly predicted adherence status on the event risk, and how imperfect sensitivity and specificity affect the cost balance if a supporting intervention was offered to patients classified as non-adherent. Our simulation results suggest applying a rather high threshold (90 %) for discrimination between patients at low or high risk for non-adherence by a prediction model in order to assure cost-efficient implementation. | ||
| 650 | 4 | |a Adherence - Compliance - Persistance | |
| 650 | 4 | |a claims data | |
| 650 | 4 | |a Clinical prediction model | |
| 650 | 4 | |a direct oral anticoagulants (DOAC) | |
| 650 | 4 | |a Pharmacotherapy | |
| 650 | 4 | |a rivaroxaban | |
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| 900 | |a Meid, Andreas D. | ||
| 900 | |a Meid, Andreas Daniel | ||
| 900 | |a Haefeli, W. E. | ||
| 900 | |a Haefeli, W. | ||
| 900 | |a Haefeli, Walter Emil | ||
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| contents | Patients who do not sufficiently adhere to their dosing regimens will, ultimately, do not get the full benefit of their medication. For example, if direct oral anticoagulants (DOAC) are not taken continuously, an intervention to improve adherence or maintain persistence will show direct effects on clinical outcomes. Usually, adherent patients are defined by taking ≥ 80 % of their medication. The resulting binary adherence status from this threshold can as well be used for predictive classification. Thus, the threshold can determine the prediction model’s performance to identify patients at risk for poor adherence by this binary adherence status. In this perspective, we propose a plan for model development and performance considering the threshold’s role. Concerning development demands, we extracted predictors from a systematic literature search on DOAC adherence to be used as a core set of candidate predictors. Independently, we investigated how well a future model would technically have to perform by modeling drug intake and thromboembolic events based on a rivaroxaban pharmacokinetic-pharmacodynamic model. Using this simulation framework for different thresholds, we projected the impact of an imperfectly predicted adherence status on the event risk, and how imperfect sensitivity and specificity affect the cost balance if a supporting intervention was offered to patients classified as non-adherent. Our simulation results suggest applying a rather high threshold (90 %) for discrimination between patients at low or high risk for non-adherence by a prediction model in order to assure cost-efficient implementation. |
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| spelling | Ruff, Carmen 1989- VerfasserIn (DE-588)1181827671 (DE-627)1662402171 aut, The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence Carmen Ruff, Ludmila Koukalova, Walter E. Haefeli and Andreas D. Meid, 19 February 2019, Text txt rdacontent, Computermedien c rdamedia, Online-Ressource cr rdacarrier, Gesehen am 09.05.2019, Patients who do not sufficiently adhere to their dosing regimens will, ultimately, do not get the full benefit of their medication. For example, if direct oral anticoagulants (DOAC) are not taken continuously, an intervention to improve adherence or maintain persistence will show direct effects on clinical outcomes. Usually, adherent patients are defined by taking ≥ 80 % of their medication. The resulting binary adherence status from this threshold can as well be used for predictive classification. Thus, the threshold can determine the prediction model’s performance to identify patients at risk for poor adherence by this binary adherence status. In this perspective, we propose a plan for model development and performance considering the threshold’s role. Concerning development demands, we extracted predictors from a systematic literature search on DOAC adherence to be used as a core set of candidate predictors. Independently, we investigated how well a future model would technically have to perform by modeling drug intake and thromboembolic events based on a rivaroxaban pharmacokinetic-pharmacodynamic model. Using this simulation framework for different thresholds, we projected the impact of an imperfectly predicted adherence status on the event risk, and how imperfect sensitivity and specificity affect the cost balance if a supporting intervention was offered to patients classified as non-adherent. Our simulation results suggest applying a rather high threshold (90 %) for discrimination between patients at low or high risk for non-adherence by a prediction model in order to assure cost-efficient implementation., Adherence - Compliance - Persistance, claims data, Clinical prediction model, direct oral anticoagulants (DOAC), Pharmacotherapy, rivaroxaban, Haefeli, Walter E. 1958- VerfasserIn (DE-588)124572359 (DE-627)656806141 (DE-576)340514221 aut, Meid, Andreas 1981- VerfasserIn (DE-588)1076301991 (DE-627)834660377 (DE-576)445184582 aut, Enthalten in Frontiers in pharmacology Lausanne : Frontiers Media, 2010 10(2019) Artikel-Nummer 113, 7 Seiten Online-Ressource (DE-627)642889392 (DE-600)2587355-6 (DE-576)335527108 1663-9812 nnns, volume:10 year:2019, https://doi.org/10.3389/fphar.2019.00113 Verlag Resolving-System kostenfrei Volltext, https://www.frontiersin.org/articles/10.3389/fphar.2019.00113/full Verlag kostenfrei Volltext, https://www.frontiersin.org/articles/10.3389/fphar.2019.00113/full LFER, LFER 2019-05-29T00:00:00Z |
| spellingShingle | Ruff, Carmen, Haefeli, Walter E., Meid, Andreas, The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence, Patients who do not sufficiently adhere to their dosing regimens will, ultimately, do not get the full benefit of their medication. For example, if direct oral anticoagulants (DOAC) are not taken continuously, an intervention to improve adherence or maintain persistence will show direct effects on clinical outcomes. Usually, adherent patients are defined by taking ≥ 80 % of their medication. The resulting binary adherence status from this threshold can as well be used for predictive classification. Thus, the threshold can determine the prediction model’s performance to identify patients at risk for poor adherence by this binary adherence status. In this perspective, we propose a plan for model development and performance considering the threshold’s role. Concerning development demands, we extracted predictors from a systematic literature search on DOAC adherence to be used as a core set of candidate predictors. Independently, we investigated how well a future model would technically have to perform by modeling drug intake and thromboembolic events based on a rivaroxaban pharmacokinetic-pharmacodynamic model. Using this simulation framework for different thresholds, we projected the impact of an imperfectly predicted adherence status on the event risk, and how imperfect sensitivity and specificity affect the cost balance if a supporting intervention was offered to patients classified as non-adherent. Our simulation results suggest applying a rather high threshold (90 %) for discrimination between patients at low or high risk for non-adherence by a prediction model in order to assure cost-efficient implementation., Adherence - Compliance - Persistance, claims data, Clinical prediction model, direct oral anticoagulants (DOAC), Pharmacotherapy, rivaroxaban |
| title | The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence |
| title_auth | The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence |
| title_full | The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence Carmen Ruff, Ludmila Koukalova, Walter E. Haefeli and Andreas D. Meid |
| title_fullStr | The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence Carmen Ruff, Ludmila Koukalova, Walter E. Haefeli and Andreas D. Meid |
| title_full_unstemmed | The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence Carmen Ruff, Ludmila Koukalova, Walter E. Haefeli and Andreas D. Meid |
| title_in_hierarchy | The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence / Carmen Ruff, Ludmila Koukalova, Walter E. Haefeli and Andreas D. Meid, |
| title_short | The role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence |
| title_sort | role of adherence thresholds for development and performance aspects of a prediction model for direct oral anticoagulation adherence |
| topic | Adherence - Compliance - Persistance, claims data, Clinical prediction model, direct oral anticoagulants (DOAC), Pharmacotherapy, rivaroxaban |
| topic_facet | Adherence - Compliance - Persistance, claims data, Clinical prediction model, direct oral anticoagulants (DOAC), Pharmacotherapy, rivaroxaban |
| url | https://doi.org/10.3389/fphar.2019.00113, https://www.frontiersin.org/articles/10.3389/fphar.2019.00113/full |