title: Long-term use and cost-effectiveness of secondary prevention drugs for heart disease in Western Australian seniors (WAMACH): a study protocol.
abstract: BACKGROUND
  Secondary prevention drugs for cardiac disease have been demonstrated by clinical trials to be effective in reducing future cardiovascular and mortality events (WAMACH is the Western Australian Medication Adherence and Costs in Heart disease study). Hence, most countries have adopted health policies and guidelines for the use of these drugs, and included them in government subsidised drug lists to encourage their use. However, suboptimal prescribing and non-adherence to these drugs remains a universal problem. Our study will investigate trends in dispensing patterns of drugs for secondary prevention of cardiovascular events and will also identify factors influencing these patterns. It will also assess the clinical and economic consequences of non-adherence and the cost-effectiveness of using these drugs.
  
  
  METHODS
  This population-based cohort study will use longitudinal data on almost 40,000 people aged 65 years or older who were hospitalised in Western Australia between 2003 and 2008 for coronary heart disease, heart failure or atrial fibrillation. Linking of several State and Federal government administrative data sets will provide person-based information on drugs dispensed precardiac and postcardiac event, reasons for hospital admission, emergency department visits, mortality and medical visits. Dispensed drug trends will be described, drug adherence measured and their association with future all-cause/cardiovascular events will be estimated. The cost-effectiveness of these long-term therapies for cardiac disease and the impact of adherence will be evaluated.
  
  
  BACKGROUND
  Human Research Ethics Committee (HREC) approvals have been obtained from the Department of Health (Western Australian #2011/62 and Federal) and the University of Western Australia (RA/4/1/1130), in addition to HREC approvals from all participating hospitals. Findings will be published in peer-reviewed medical journals and presented at local, national and international conferences. Results will also be disseminated to consumer groups.
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Anthony S
authors.identifier: http://orcid.org/0000-0002-5432-6685
authors.initials: AS
authors.lastname: Gunnell
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Knuiman
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Geelhoed
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Michael S T
authors.initials: MS
authors.lastname: Hobbs
authors.affiliation: Western Australian Centre for Rural Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Katzenellenbogen
authors.affiliation: School of Medicine & Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Nedlands, Western Australia, Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hung
authors.affiliation: Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Rankin
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Lee
authors.initials: L
authors.lastname: Nedkoff
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Briffa
authors.affiliation: St Vincent's Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ortiz
authors.affiliation: MedicineInsight, NPS MedicineWise, Sydney, New South Wales, Australia.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Gillies
authors.affiliation: Consumer and Community Advisory Council, School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Cordingley
authors.affiliation: Health Consumers' Council (WA) Inc., Perth, Western Australia, Australia.
authors.forename: Mitch
authors.initials: M
authors.lastname: Messer
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Christian
authors.initials: C
authors.lastname: Gardner
authors.affiliation: Western Australian Centre for Rural Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Derrick
authors.initials: D
authors.lastname: Lopez
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Atkins
authors.affiliation: Clinical Modelling Unit, Western Australian Department of Health, Perth, Western Australia, Australia.
authors.forename: Qun
authors.initials: Q
authors.lastname: Mai
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Frank M
authors.identifier: http://orcid.org/0000-0003-3639-0787
authors.initials: FM
authors.lastname: Sanfilippo
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000517:prevention & control; D002316:Cardiotonic Agents / Q000191:economics / Q000627:therapeutic use; D002985:Clinical Protocols; D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D006331:Heart Diseases / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D006333:Heart Failure / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D008134:Long-Term Care; D055118:Medication Adherence; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome; D014904:Western Australia
chemical_list: D002316:Cardiotonic Agents
keywords: CARDIOLOGY; CLINICAL PHARMACOLOGY; HEALTH ECONOMICS