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Snyman JR, Bortolotto LA, Degli Esposti L, Jayagopal PB, Konradi AO, Perrone V, Borghi C. A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy. J Hypertens 2024; 42:136-142. [PMID: 37728093 PMCID: PMC10712996 DOI: 10.1097/hjh.0000000000003570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/21/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES This analysis compared adherence, cardiovascular (CV) events and all-cause mortality incidence, and healthcare costs among hypertensive patients treated with perindopril (PER)/indapamide (IND)/amlodipine (AML) in single-pill combination (SPC) vs. multiple-pill combination, in a real-world setting in Italy. METHODS In this observational retrospective analysis of Italian administrative databases, adult patients treated with PER/IND/AML between 2010 and 2020 were divided into two cohorts: single-pill vs. multiple-pill. Patient data were available for at least one year before and after index date. Propensity score matching (PSM) was applied to reduce selection bias. Adherence was defined as proportion of days covered: non-adherence, <40%; partial adherence, 40-79%, and adherence ≥80%. Mortality incidence and CV events as single, or composite, endpoints were evaluated after first year of follow-up. Healthcare cost analyses were performed from the perspective of the Italian National Health Service. RESULTS Following PSM, the single-pill cohort included 12 150 patients, and the multiple-pill cohort, 6105. The SPC cohort had a significantly higher percentage of adherent patients vs. the multiple-pill cohort (59.9% vs. 26.9%, P < 0.001). Following the first year of follow-up, incidence of all-cause mortality, and combined endpoint of all-cause mortality and CV events were lower in the SPC cohort compared with multiple-pill cohort. Average annual direct healthcare costs were lower in the single-pill cohort (€2970) vs. multiple-pill cohort (€3642); cost of all drugs and all-cause hospitalizations were major contributors. CONCLUSION The SPC of PER/IND/AML, compared with multiple-pill combination, is associated with higher adherence to medication, lower incidence of CV events and mortality, and reduced healthcare costs.
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Affiliation(s)
- Jacques R. Snyman
- Forte Research (Pty ltd) and Private Practice South Africa, Pretoria, South Africa
| | | | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
| | | | | | - Valentina Perrone
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
| | - Claudio Borghi
- University of Bologna, IRCCS Ospedale S. Orsola, Bologna, Italy
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Borghi C, Granados D. Estimating the impact of single pill combination therapy for hypertension: projections of patient outcomes in Italy. J Cardiovasc Med (Hagerstown) 2023; 24:714-720. [PMID: 37577918 PMCID: PMC10521767 DOI: 10.2459/jcm.0000000000001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Hypertension affects almost a third of the Italian population and is a major risk factor for cardiovascular disease. Management of hypertension is often hindered by poor adherence to complex treatment regimens. This analysis aimed to estimate the 10-year clinical outcomes associated with single pill combination (SPC) therapies compared with other treatment pathways for the management of hypertension in Italy. METHODS A microsimulation modeling approach was used to project health outcomes over a 10-year period for people with hypertension. Input data for four treatment pathways [current treatment practices (CTP), single drug with dosage titration then sequential addition of other agents (start low and go slow, SLGS), free choice combination with multiple pills (FCC) and SPC] were sourced from the Global Burden of Disease 2017 data set. The model simulated clinical outcomes for 1 000 000 individuals in each treatment pathway, including mortality, chronic kidney disease (CKD), stroke, ischemic heart disease (IHD) and disability-adjusted life years (DALYs). RESULTS Through improved adherence, SPC was projected to improve clinical outcomes versus CTP, SLGS, and FCC. SPC was associated with reductions in mortality, incidence of clinical events, and DALYs versus CTP of 5.4%, 11.5%, and 5.7%, respectively. SLGS and FCC were associated with improvements in clinical outcomes versus CTP, but smaller improvements than those associated with SPC. CONCLUSIONS Over 10 years, combination therapies (including SPC and FCC) were projected to reduce the burden of hypertension compared with conventional management approaches in Italy. Due to higher adherence, SPC was associated with the greatest overall benefits versus other regimens.
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Treciokiene I, Bratcikoviene N, Gulbinovic J, Wettermark B, Taxis K. Non-persistence to antihypertensive drug therapy in Lithuania. Eur J Clin Pharmacol 2022; 78:1687-1696. [PMID: 35918539 PMCID: PMC9482566 DOI: 10.1007/s00228-022-03369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022]
Abstract
Purpose Poor persistence to antihypertensive therapy is an important cause of treatment failure. Investigating persistence is especially important in countries with a high cardiovascular mortality, like Lithuania. The aim of this study was to describe the antihypertensive treatment at initiation, to determine the percentage of patients not being persistent with antihypertensive treatment after 1 year and to explore factors associated with non-persistence. Methods In this cohort study, data on dispensed prescription medicines from the Lithuanian National Health Insurance Fund (NHIF) were used. All adult patients with a diagnosis of hypertension having first antihypertensive dispensed in 2018 were included. Descriptive statistics was used to determine the number of patients started with monotherapy and combination therapy. Treatment choice by Anatomical Therapeutic Chemical (ATC) and number of active pharmaceutical ingredient (API) was described. Non-persistence was assessed using the anniversary method. Multivariate logistic regression was used to explore factors associated with non-persistence. Results A total of 72,088 patients were included into the study, 56% started on monotherapy treatment, with 49% being dispensed an angiotensin converting enzyme inhibitor, and 44% started on combination therapy. Overall, 57% of patients were non-persistent after 1 year. Patients’ gender and prescriber qualification showed no association with non-persistence. Younger patients, patients from rural area, patients started with monotherapy, and patients with no medication change had higher odds to become non-persistent. Conclusions The majority of patients were initiated with treatment following hypertension management guidelines, but it is of concern that over half of the patients were non-persistent to antihypertensive therapy in the first year.
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Affiliation(s)
- Indre Treciokiene
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, -Epidemiology & -Economics, Groningen, Netherlands. .,Pharmacy Center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Nomeda Bratcikoviene
- Department of Mathematical Statistics, Faculty of Fundamental Sciences, Vilnius Tech, Vilnius, Lithuania.,Department of Human and Medical Genetics, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Bjorn Wettermark
- Pharmacy Center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Katja Taxis
- Department of PharmacoTherapy, -Epidemiology & -Economics, Faculty of Science and Engineering, University of Groningen, -Epidemiology & -Economics, Groningen, Netherlands
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Wilke T, Weisser B, Predel HG, Schmieder RE, Wassmann S, Gillessen A, Blettenberg J, Maywald U, Randerath O, Müller S, Böhm M. Effects of cardiovascular single pill combinations compared with identical multi-pill therapies on healthcare cost and utilization in Germany. J Comp Eff Res 2022; 11:411-422. [PMID: 35315281 DOI: 10.2217/cer-2021-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study assessed whether a single pill combination (SPC) is associated with lower direct healthcare costs. Materials & methods: Anonymized claims data of patients ≥18 years treated with drugs for cardiovascular (CV)-related diseases either as a single pill combination or multi-pill combination (follow-up to 1 year) were evaluated. After propensity score matching, 59,336 out of 1,369,840 patients were analyzed. Results: In all cohorts, patients receiving a single pill combination had a lower frequency of general practitioner and specialist visits. The patients also had a significantly lower ratio of all-cause hospitalization days and number of CV-related prescriptions as well as all-cause prescriptions (with one exception) compared with those receiving a multi-pill combination. Conclusion: Direct CV-related costs were significantly lower in four out of seven comparisons, with a trend toward lower costs in the other three comparisons.
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Affiliation(s)
- Thomas Wilke
- Institute for Pharmacoeconomics & drug logistics, University of Wismar, 23966, Germany
| | - Burkhard Weisser
- Institute of Sports Science, Christian-Albrechts-University of Kiel, Kiel, 24118, Germany
| | - Hans-Georg Predel
- Institute of Cardiology & Sports Medicine, German Sport University, Cologne, 50933, Germany
| | - Roland E Schmieder
- Department of Nephrology & Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen Nürnberg, Erlangen, 91054, Germany
| | - Sven Wassmann
- Department of Inner medicine & Cardiology, Cardiology Pasing, Munich, 81241, Germany & Faculty of Medicine, University of the Saarland, Homburg/Saar, 66123, Germany
| | - Anton Gillessen
- Department of Internal Medicine, Herz-Jesu-Hospital, Münster, 48165, Germany
| | | | - Ulf Maywald
- Drug department, AOK PLUS, Dresden, 01067, Germany
| | - Olaf Randerath
- Medical Department, APONTIS PHARMA Germany GmbH & Co. KG, Monheim, 40789, Germany
| | - Sabrina Müller
- Department of Real-World Evidence & Evidence Synthesis, Ingress-Health HWM GmbH, Wismar, 23966, Germany
| | - Michael Böhm
- Clinic for Internal Medicine III, University clinic of Saarlandes, Saarland University, Homburg/Saar, Germany
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Bekker CL, Aslani P, Chen TF. The use of medication adherence guidelines in medication taking behaviour research. Res Social Adm Pharm 2021; 18:2325-2330. [PMID: 34393079 DOI: 10.1016/j.sapharm.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
Medication nonadherence continues to be a serious issue in a range of long-term medical conditions and has been studied extensively over the past few decades. However, despite the plethora of research studies on medication adherence, poor methodological rigour in many studies has contributed to limited generalisability of the positive findings, limited impact on patients' medication adherence, and inability to compare between studies. This paper focuses on current guidelines designed specifically for research on medication adherence. It discusses key elements to consider during study design, selection of adherence measurements, and reporting on medication adherence research, to ensure a higher quality of research in medication adherence. Overall, there appears to be variations in adherence terminology reported in the literature despite improvements in defining medication taking behaviour and the availability of taxonomies. In addition, limited guidance exists on how best to measure adherence. Recommendations are provided on appropriate adherence measures for the adherence behaviour being investigated, including careful consideration of adherence concepts, validity of adherence instruments, appropriate instrument selection, definition of nonadherence threshold, and how to report medication adherence. Improving adherence research requires greater clarity and standardisation of descriptions of nonadherence behaviour, increased methodological rigour in study designs, better selection of adherence measurements, and comprehensive reporting.
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Affiliation(s)
- Charlotte L Bekker
- Radboud University Medical Center, Research Institute for Health Sciences, Department of Pharmacy, Nijmegen, the Netherlands.
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Timothy F Chen
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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Godman B, McCabe H, D Leong T. Fixed dose drug combinations - are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries. Expert Rev Pharmacoecon Outcomes Res 2020; 20:1-26. [PMID: 32237953 DOI: 10.1080/14737167.2020.1734456] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: There are positive aspects regarding the prescribing of fixed dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower- and middle-income countries (LMICs) which have the greatest prevalence of both infectious and noninfectious diseases and issues of affordability.Areas covered: Review of potential advantages, disadvantages, cost-effectiveness, and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where there are concerns with their value.Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates, and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis, and hypertension are valued and listed in the country's essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which are being addressed.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Holly McCabe
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Trudy D Leong
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Patient Centric Pharmaceutical Drug Product Design-The Impact on Medication Adherence. Pharmaceutics 2020; 12:pharmaceutics12010044. [PMID: 31947888 PMCID: PMC7023035 DOI: 10.3390/pharmaceutics12010044] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022] Open
Abstract
Medication adherence is a growing concern for public health and poor adherence to therapy has been associated with poor health outcomes and higher costs for patients. Interventions for improving adherence need to consider the characteristics of the individual therapeutic regimens according to the needs of the patients. In particular, geriatric and paediatric populations as well as dermatological patients have special needs/preferences that should be considered when designing drug products. Patient Centric Drug Product Pharmaceutical Design (PCDPD) offers the opportunity to meet the needs and preferences of patients. Packaging, orodispersible formulations, fixed dose combinations products, multiparticulate formulations, topical formulations and 3D printing are of particular relevance in a PCDPD process. These will be addressed in this review as well as their impact on medication adherence.
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