School of Population Health, University of New South Wales, Sydney, NSW, Australia.
Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia.
Heart Lung Circ. 2022 Jul;31(7):954-963. doi: 10.1016/j.hlc.2022.01.010. Epub 2022 Feb 25.
Single-pill combination (SPC) therapy is recommended as first-line therapy for most patients in global hypertension guidelines due to benefits of improved adherence and blood pressure (BP) control. We aimed to understand factors affecting SPC use in the management of raised BP in Australia.
A mixed-method study comprising of qualitative (policy review and interviews) and quantitative (Pharmaceutical Benefits Scheme [PBS] data) approaches.
Australian and international hypertension guideline recommendations regarding SPC use; the Australian registration and subsidy approval processes of SPCs; use of SPCs on the PBS; cost-analysis of PBS-listed SPCs compared to free-drug combinations; perceptions of healthcare providers towards SPCs.
The 2016 Australian Heart Foundation's "Guideline for the diagnosis and management of hypertension in adults" does not recommend combination therapy (including SPCs) as first-line treatment. Additional challenges in the uptake of SPCs include: (1) the additional PBS requirements and barriers imposed for the listing of SPCs. (2) Script volumes for SPCs have not matched the rise in the number of SPCs listed for subsidy, have plateaued since 2016 and remained significantly lower than single constituent scripts. (3) SPCs are not subsidised by the PBS for initial treatment. Most SPCs provided substantial cost savings for individual patients compared to free-drug combinations. Health care providers were positive about the cost-saving and convenience of SPCs, however perceived negatives included inflexibility of SPCs during dose titration, medicine shortages, and potential adverse effects when initiating treatment with multiple drugs.
The safety, efficacy and cost-saving potential of SPCs have been established in the literature but several roadblocks in the existing health system in Australia impede uptake. Interventions addressing these barriers may facilitate improved uptake, which may in turn improve blood pressure control in Australia.
由于提高了依从性和血压（BP）控制的益处，全球高血压指南建议将单片复方治疗（SPC）作为大多数患者的一线治疗。我们旨在了解影响 SPC 在澳大利亚升高 BP 管理中的使用的因素。
一项混合方法研究，包括定性（政策审查和访谈）和定量（药品福利计划 [PBS] 数据）方法。
澳大利亚和国际高血压指南关于 SPC 使用的建议；SPC 的澳大利亚注册和补贴批准程序；PBS 上 SPC 的使用；与自由药物组合相比，PBS 上市的 SPC 的成本分析；医疗保健提供者对 SPC 的看法。
2016 年澳大利亚心脏基金会的“高血压诊断和管理指南”不建议将联合治疗（包括 SPC）作为一线治疗。采用 SPC 的额外挑战包括：（1）PBS 对 SPC 上市的额外要求和障碍。（2）SPC 的处方量与上市 SPC 的数量增加不匹配，自 2016 年以来趋于平稳，且明显低于单个成分的处方量。（3）SPC 未通过 PBS 补贴初始治疗。与自由药物组合相比，大多数 SPC 为个别患者提供了实质性的成本节省。医疗保健提供者对 SPC 的成本节约和便利性持积极态度，但认为 SPC 的缺点包括在剂量滴定期间的灵活性差、药物短缺以及开始用多种药物治疗时潜在的不良反应。
SPC 的安全性、疗效和成本节约潜力已在文献中得到证实，但澳大利亚现有卫生系统中的几个障碍阻碍了其采用。解决这些障碍的干预措施可能会促进更好的采用，从而改善澳大利亚的血压控制。
