Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
J Med Econ. 2011;14(3):267-78. doi: 10.3111/13696998.2011.570401. Epub 2011 Mar 30.
To evaluate the relationship between drug copayment level and persistence and the implications of non-persistence on healthcare utilization and costs among adult hypertension patients receiving single-pill combination (SPC) therapy.
Patients initiated on SPC with angiotensin receptor blocker (ARB) + calcium channel blocker, ARB + hydrochlorothiazide, or angiotensin-converting enzyme inhibitors + hydrochlorothiazide were identified in the MarketScan Database (2006-2008). Multivariate models were used to assess copayment level as a predictor of 3-month and 6-month persistence. Three levels of copayment were considered (low: ≤$5, medium: $5-30, high: >$30 for <90-day supply; low: ≤$10, medium: $10-60, high: >$60 for ≥90-day supply). Separate models examined the implications of persistence during the first 3 months on outcomes during the subsequent 3-month period, including utilization and changes in healthcare costs from baseline. National- and state-level outcomes were analyzed.
Analyses of 381,661 patients found significantly lower 3-month and 6-month persistence to therapies with high copayments. Relative to high-copayment drugs, risk-adjusted odds ratios at 3 months were 1.29 (95% confidence interval [CI]: 1.26, 1.32) and 1.27 (95% CI: 1.24, 1.30) for low- and medium-copayment medications, respectively. The strength of the association between copayment and persistence varied across states. Non-persistent patients had significantly more cardiovascular-related hospitalizations (incidence rate ratio [IRR] = 1.36; 95% CI: 1.30, 1.43) and emergency room (ER) visits (IRR = 1.51; 95% CI: 1.43, 1.59) than persistent patients. Non-persistence was associated with significantly larger increases in all-cause medical services cost by $277 (95% CI: $225, $329), but lesser increases in prescription costs by -$81 (95% CI: -$85, -$76).
Limitations include the possibility of confounding from unobserved factors (e.g., patient income), and the lack of blood pressure data.
High copayment for SPC therapy was associated with significantly worse persistence among hypertensive patients. Persistence was associated with substantially lower frequencies of hospitalizations and ER visits and net healthcare cost savings.
评估药物自付额水平与持续性之间的关系，以及非持续性对接受单片复方制剂（SPC）治疗的成年高血压患者医疗利用和成本的影响。
在 MarketScan 数据库（2006-2008 年）中确定了起始使用血管紧张素受体阻滞剂（ARB）+钙通道阻滞剂、ARB+氢氯噻嗪或血管紧张素转换酶抑制剂+氢氯噻嗪的 SPC 治疗的患者。采用多变量模型评估自付额水平作为 3 个月和 6 个月持续性的预测因子。考虑了三个自付额水平（低：≤$5，中：$5-30，高：<90 天供应的>$30；低：≤$10，中：$10-60，高：≥90 天供应的>$60）。单独的模型研究了前 3 个月的持续性对随后 3 个月期间结局的影响，包括基线时的医疗利用和医疗成本变化。分析了国家和州级结局。
对 381661 名患者的分析发现，高自付额治疗的 3 个月和 6 个月持续性显著降低。与高自付额药物相比，低自付额药物和中自付额药物的风险调整后 3 个月优势比分别为 1.29（95%置信区间[CI]：1.26，1.32）和 1.27（95% CI：1.24，1.30）。自付额与持续性之间的关联强度在各州之间存在差异。非持续性患者的心血管相关住院治疗（发生率比[IRR] = 1.36；95% CI：1.30，1.43）和急诊室（ER）就诊（IRR = 1.51；95% CI：1.43，1.59）明显多于持续性患者。与持续性患者相比，非持续性患者的全因医疗服务费用显著增加 277 美元（95% CI：225 美元，329 美元），而处方费用仅减少 81 美元（95% CI：-85 美元，-76 美元）。
存在混杂因素（如患者收入）的可能性和缺乏血压数据等局限性。
SPC 治疗的高自付额与高血压患者的持续性显著降低相关。持续性与住院和 ER 就诊的频率显著降低以及净医疗保健成本节省相关。
