与多片 ARB/CCB 方案相比，单片 ARB/CCB 联合治疗的依从性和持久性。
Adherence and persistence of single-pill ARB/CCB combination therapy compared to multiple-pill ARB/CCB regimens.
机构信息
MedImpact Healthcare Systems, Inc., San Diego, CA, USA.
出版信息
Curr Med Res Opin. 2010 Dec;26(12):2877-87. doi: 10.1185/03007995.2010.534129. Epub 2010 Nov 11.
OBJECTIVE
To evaluate the impact of angiotensin receptor blocker (ARBs)/dihydropyridine calcium channel blockers (CCBs) single-pill combination (SPC) on adherence to antihypertensive treatment in comparison to free combination of ARBs and CCBs.
RESEARCH DESIGN AND METHODS
A retrospective data analysis was performed using pharmacy claims data from a national pharmacy benefit management company. The study included patients who were newly initiated on ARB/CCB treatment between 01/01/2007 and 08/31/2008, aged ≥ 18 years, and continuously enrolled in the same health plan for 12 months prior to and 13 months after starting ARB/CCB treatment. Outcome variables were persistence, defined as time to discontinuation of therapy, and adherence, defined as proportion of days covered (PDC) ≥ 0.80. Propensity score weighting was used to balance the characteristics of the two groups.
RESULTS
The final sample contained 2312 patients in the free-combination group and 2213 patients in the SPC group. Patients in the SPC group and the free-combination group were different in age, gender, type of insurance, history of antihypertensive therapy and co-morbidities. These differences were largely normalized after propensity score adjustment. Multivariate logistic model regression showed that patients in the SPC group had a 90% greater odds of being adherent to index therapy compared to patients in the free-combination group (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.75-2.08, p< 0.001). A Cox proportional hazards model showed that patients in the SPC group were less likely to discontinue ARB/CCB SPC therapy compared to patients in the free-combination group (hazard ratio [HR] 0.66, 95% CI 0.63-0.70, p < 0.001). In both models, higher copayment (copayment $50 and above) was associated with worse persistence and adherence in comparison to patients who had a lower copayment ($0-$5): HR = 1.23, p < 0.001 and OR = 0.67, p < 0.001.
CONCLUSION
Patients using SPC ARB/CCB therapy were more likely to be persistent and adherent to treatment compared to patients taking free-combination therapy.
目的
评估血管紧张素受体阻滞剂（ARB）/二氢吡啶类钙通道阻滞剂（CCB）单片复方制剂（SPC）与 ARB 和 CCB 自由联合治疗相比，对降压治疗依从性的影响。
研究设计和方法
使用全国性药房福利管理公司的药房理赔数据进行回顾性数据分析。该研究纳入了 2007 年 1 月 1 日至 2008 年 8 月 31 日期间首次开始 ARB/CCB 治疗、年龄≥18 岁、并在开始 ARB/CCB 治疗前 12 个月和治疗后 13 个月持续参加同一健康计划的患者。主要转归指标为治疗停药时间（定义为持久性）和治疗依从性（定义为比例达标率[PDC]≥0.80）。采用倾向评分加权法平衡两组的特征。
结果
自由联合组最终样本包含 2312 例患者，SPC 组最终样本包含 2213 例患者。SPC 组和自由联合组患者在年龄、性别、保险类型、降压治疗史和合并症方面存在差异。这些差异在倾向评分调整后基本得到纠正。多变量逻辑模型回归显示，与自由联合组相比，SPC 组患者的指数治疗依从性高出 90%（比值比[OR] 1.90，95%置信区间[CI] 1.75-2.08，p<0.001）。Cox 比例风险模型显示，与自由联合组相比，SPC 组患者停止 ARB/CCB SPC 治疗的可能性更小（风险比[HR] 0.66，95%CI 0.63-0.70，p < 0.001）。在这两种模型中，与低自付额（0-5 美元）相比，较高的共付额（50 美元及以上）与较差的持久性和依从性相关：HR=1.23，p<0.001，OR=0.67，p<0.001。
结论
与使用 ARB 和 CCB 自由联合治疗的患者相比，使用 SPC ARB/CCB 治疗的患者更有可能持续并坚持治疗。
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