Fixed Versus Free Combinations Of Antihypertensive Drugs: Analyses Of Real-World Data Of Persistence With Therapy In Italy
Received 31 July 2019
Accepted for publication 15 October 2019
Published 11 November 2019 Volume 2019:13 Pages 1961—1969
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Nicola Ludin
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Daria Putignano,1 Valentina Orlando,1 Valeria Marina Monetti,1 Gaetano Piccinocchi,2 Umberto Maria Musazzi,3 Roberto Piccinocchi,4 Paola Minghetti,3 Enrica Menditto1
1CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy; 2SIMG, Società Italiana di Medicina Generale, Florence, Italy; 3Dipartimento di Scienze Farmaceutiche, Università degli Studi di Milano, Milan, Italy; 4University of Naples Federico II, Naples, Italy
Correspondence: Valentina Orlando
CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Via Domenico Montesano 49, Naples 80131, Italy
Tel +39 081 678657
Fax +39 081 678303
Purpose: To analyse the pattern of use and cost of antihypertensive drugs in new users in an Italian population, and explore the patient/treatment factors associated with the risk of therapy discontinuation.
Patients and methods: In this retrospective study, information was collected from a population-based electronic primary-care database. Persistence with medication use 1 year from therapy initiation was evaluated for each user using the gap method. Each new user was classified according to his/her pattern of use as: “continuer”, “discontinuer” “switching” or “add-on”. A Cox regression model was used to analyse the factors influencing therapy discontinuation. Primary-care costs comprised specialists’ visits, diagnostic procedures and pharmacologic therapies.
Results: Among 14,999 subjects included in persistence analyses, 55.1% of cases initially started on monotherapy were classified as discontinuers vs 36.5% of cases taking combination therapy (42.3% vs 32.7%, respectively, for free and fixed combinations, P < 0.01). Old age, high cardiovascular risk and being in receipt of fixed-combination therapy were associated with greater persistence. Overall, the primary-care cost/person/year of hypertension management was ∼€95.3 (IQR, 144.9). The monotherapy cost was €88 per patient (IQR, 132.9), and that for combination therapy was €151±148.3. The median cost/patient with a fixed combination was lower than that for a free combination (€98.4 (IQR, 155.3) and €154.9 (IQR, 182.6), respectively).
Conclusion: The initial type of therapy prescribed influences persistence. Prescribing fixed combinations might be a good choice as initial therapy.
Keywords: drug-utilization, adherence, fixed combination, hypertension
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