Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
Department of Internal Medicine and Cardiology, RUDN University, Moscow, Russia.
Adv Ther. 2024 Jan;41(1):182-197. doi: 10.1007/s12325-023-02707-7. Epub 2023 Oct 21.
The present real-world analysis aims to compare the drug utilization, hospitalizations and direct healthcare costs related to the use of single-pill combination (SPC) or free-equivalent combination (FEC) of perindopril and bisoprolol (PER/BIS) in a large Italian population.
This observational retrospective analysis was based on administrative databases covering approximately 7 million subjects across Italy. All adult subjects receiving PER/BIS as SPC or FEC between January 2017-June 2020 were included. Subjects were followed for 1 year after the first prescription of PER/BIS as FEC (± 1 month) or SPC. Before comparing the SPC and FEC cohorts, propensity score matching (PSM) was applied to balance the baseline characteristics. Drug utilization was investigated as adherence (defined by the proportion of days covered, PDC) and persistence (evaluated by Kaplan-Meier curves). Hospitalizations and mean annual direct healthcare costs (due to drug prescriptions, hospitalizations and use of outpatient services) were analyzed during follow-up.
The original cohort included 11,440 and 6521 patients taking the SPC and FEC PER/BIS combination, respectively. After PSM, two balanced SPC and FEC cohorts of 4688 patients were obtained (mean age 70 years, approximately 50% male, 24% in secondary prevention). The proportion of adherent patients (PDC ≥ 80%) was higher for those on SPC (45.5%) than those on FEC (38.6%), p < 0.001. The PER/BIS combination was discontinued by 35.8% of patients in the SPC cohort and 41.7% in the FEC cohort (p < 0.001). The SPC cohort had fewer cardiovascular (CV) hospitalizations (5.3%) than the free-combination cohort (7.4%), p < 0.001. Mean annual total healthcare costs were lower in the SPC (1999€) than in the FEC (2359€) cohort (p < 0.001).
In a real-world setting, patients treated with PER/BIS SPC showed higher adherence, lower risk of drug discontinuation, reduced risk of CV hospitalization, and lower healthcare costs than those on FEC of the same drugs.
本真实世界分析旨在比较培哚普利/比索洛尔单药复方（SPC）与自由复方（FEC）在意大利大型人群中的药物利用、住院和直接医疗保健成本。
本回顾性观察性分析基于涵盖意大利约 700 万受试者的行政数据库。纳入 2017 年 1 月至 2020 年 6 月期间接受培哚普利/比索洛尔 SPC 或 FEC 的所有成年患者。在接受培哚普利/比索洛尔 FEC（±1 个月）或 SPC 的首次处方后，对患者进行为期 1 年的随访。在比较 SPC 和 FEC 队列之前，应用倾向评分匹配（PSM）来平衡基线特征。通过药物利用（通过覆盖天数比例 PDC 评估）和持久性（通过 Kaplan-Meier 曲线评估）来研究药物利用情况。在随访期间分析了住院和平均年度直接医疗保健成本（归因于药物处方、住院和门诊服务的使用）。
原始队列分别纳入 11440 例和 6521 例接受 SPC 和 FEC 培哚普利/比索洛尔组合的患者。PSM 后，获得了两个平衡的 SPC 和 FEC 队列，各有 4688 例患者（平均年龄 70 岁，约 50%为男性，24%处于二级预防）。SPC 组（45.5%）的依从性患者（PDC≥80%）比例高于 FEC 组（38.6%），p<0.001。SPC 队列中有 35.8%的患者停用了培哚普利/比索洛尔组合，而 FEC 队列中有 41.7%的患者停用了培哚普利/比索洛尔组合（p<0.001）。SPC 队列的心血管（CV）住院率（5.3%）低于 FEC 队列（7.4%），p<0.001。SPC 队列的年度总医疗保健成本（1999 欧元）低于 FEC 队列（2359 欧元），p<0.001。
在真实环境中，与接受培哚普利/比索洛尔 FEC 的患者相比，接受培哚普利/比索洛尔 SPC 治疗的患者具有更高的依从性、更低的药物停药风险、更低的 CV 住院风险和更低的医疗保健成本。
