Drug delivery: antibiotics and vaccines

 Two recent papers discuss different issues concerning drug delivery to those in need, where the obstacles may be individual reluctance to take the drug (antibiotics) or lack of social support for the drug program (for vaccines):

Predicting and improving patient-level antibiotic adherence

Isabelle Rao, Adir Shaham, Amir Yavneh, Dor Kahana, Itai Ashlagi, Margaret L. Brandeau & Dan Yamin, Health Care Management Science (2020), 05 October 2020

Abstract: Low adherence to prescribed medications causes substantial health and economic burden. We analyzed primary data from electronic medical records of 250,000 random patients from Israel’s Maccabi Healthcare services from 2007 to 2017 to predict whether a patient will purchase a prescribed antibiotic. We developed a decision model to evaluate whether an intervention to improve purchasing adherence is warranted for the patient, considering the cost of the intervention and the cost of non-adherence. The best performing prediction model achieved an average area under the receiver operating characteristic curve (AUC) of 0.684, with 82% accuracy in detecting individuals who had less than 50% chance of purchasing a prescribed drug. Using the decision model, an adherence intervention targeted to patients whose predicted purchasing probability is below a specified threshold can increase the number of prescriptions filled while generating significant savings compared to no intervention – on the order of 6.4% savings and 4.0% more prescriptions filled for our dataset. We conclude that analysis of large-scale patient data from electronic medical records can help predict the probability that a patient will purchase a prescribed antibiotic and can provide real-time predictions to physicians, who can then counsel the patient about medication importance. More broadly, in-depth analysis of patient-level data can help shape the next generation of personalized interventions.

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Covid-19: how to prioritize worse-off populations in allocating safe and effective vaccines

Harald Schmidt, Parag Pathak, Tayfun Sönmez, and M Utku Ünver, BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3795 (Published 05 October 2020)

"When compared with previous pandemics covid-19 is unique, not only in its substantial economic impact but in exposing the consequences of historical and ongoing structural disadvantages among minority groups,123 particularly in the US. Minorities have experienced far higher rates of unemployment, infections, hospital admissions, and deaths.23456 So, as safe and effective vaccines become likely but in limited supply, should policy makers prioritize worse-off minorities in their allocation of stocks?

"Traditional allocation focuses on maximizing overall benefits, with less regard to how these benefits are distributed among different population groups. Giving more vaccines to disadvantaged groups who are expected to live less long would generally be deemed undesirable. However, the current debate around covid-19 vaccines indicates a profound reorientation in what worse-off population groups are owed."