Machnicki G, Ong S H, Chen W, Wei Z J, Kahler K H
a a Janssen Latin America , Buenos Aires , Argentina.
b b Novartis Pharma AG , Basel , Switzerland.
Curr Med Res Opin. 2015 Dec;31(12):2287-96. doi: 10.1185/03007995.2015.1098598. Epub 2015 Nov 11.
To determine whether amlodipine/valsartan/hydrochlorothiazide single pill combination (SPC) is associated with improved persistence, adherence and reduced healthcare utilization and costs compared to the corresponding free combination (FC).
Adult (≥18 years) patients covered by commercial and Medicare Supplemental insurance in the Truven MarketScan database with hypertension (HTN) diagnosis between October 2009 and December 2011 were included. At least two filled prescriptions for the SPC cohort or two periods of minimum 15 days of concurrent use of amlodipine, valsartan and hydrochlorothiazide (HCT) for the FC cohort were required. Cohorts were propensity score matched (PSM) to balance on important confounders. Outcomes included: 1) adherence (proportion of days covered [PDC] and medication possession ratio [MPR]); 2) persistence (treatment gap >30 days); 3) all-cause and HTN-specific healthcare utilization and costs at 12 months.
After cohort matching with PSM, patients taking SPC (N = 9221) exhibited better outcomes than FC (N = 1884): higher mean adherence (85.7% vs. 77.0%), mean PDC (73.8% vs. 60.6%) and persistence (46.8% vs. 23.6%) (all p < 0.0001). Patients taking SPC were associated with higher odds of persistence (OR: 3.51; 95% CI: 3.08-4.02), MPR ≥80% (OR: 2.72; 95% CI: 2.40-3.08) and PDC ≥80% (OR: 2.88; 95% CI: 2.55-3.26). After PSM, the SPC cohort exhibited statistically significantly lower mean number of resource utilization events compared to FC. Patients in the SPC cohort also had a statistically significantly (p < 0.05) lower percentage of patients with ≥1 all-cause hospitalization (15.0% vs. 18.2%), ≥1 all-cause emergency room (ER) visits (25.7 vs. 31.4%), and ≥1 ER HTN-specific visits (9.7% vs. 14.1%). The costs incurred by SPC cohort patients were 2.8% to 41.7% numerically lower than the FC cohort, statistically significant for all-cause ER costs ($430.6 vs. $549.5, p < 0.05).
Real-world data indicate an association of the amlodipine/valsartan/HCT SPC with improved adherence and persistence vs. FC with no difference in overall healthcare or hypertension specific costs between the cohorts.
确定氨氯地平/缬沙坦/氢氯噻嗪单片复方制剂（SPC）与相应的自由联合用药（FC）相比，是否能提高持续性、依从性，并降低医疗保健利用率和成本。
纳入2009年10月至2011年12月期间在Truven MarketScan数据库中被商业保险和医疗保险补充计划覆盖且诊断为高血压（HTN）的成年（≥18岁）患者。SPC队列需要至少有两份已配药处方，FC队列需要至少有两个为期至少15天的同时使用氨氯地平、缬沙坦和氢氯噻嗪（HCT）的时间段。对队列进行倾向评分匹配（PSM）以平衡重要的混杂因素。结果包括：1）依从性（覆盖天数比例[PDC]和药物持有率[MPR]）；2）持续性（治疗间隔>30天）；3）12个月时的全因和高血压特异性医疗保健利用率及成本。
经过PSM队列匹配后，服用SPC的患者（N = 9221）比服用FC的患者（N = 1884）表现出更好的结果：更高的平均依从性（85.7%对77.0%）、平均PDC（73.8%对60.6%）和持续性（46.8%对23.6%）（所有p < 0.（此处原文有误，推测应为0.0001））。服用SPC的患者持续性更高（OR：3.51；95%CI：3.08 - 4.02）、MPR≥80%（OR：2.72；95%CI：2.40 - 3.08）和PDC≥80%（OR：2.88；95%CI：2.55 - 3.26）的几率更高。经过PSM后，SPC队列的资源利用事件平均数量在统计学上显著低于FC队列。SPC队列中的患者全因住院≥1次（15.0%对18.2%）、全因急诊室（ER）就诊≥1次（25.7对31.4%）和高血压特异性ER就诊≥1次（9.7%对14.1%）的患者百分比在统计学上也显著更低（p < 0.05）。SPC队列患者产生的成本在数值上比FC队列低2.8%至41.7%，全因ER成本具有统计学显著性（430.6美元对549.5美元，p < 0.05）。
真实世界数据表明，氨氯地平/缬沙坦/HCT SPC与FC相比，依从性和持续性得到改善，且队列之间在总体医疗保健或高血压特异性成本方面无差异。
