Medication adherence, hospitalization, and healthcare resource utilization and costs in patients with pulmonary arterial hypertension treated with endothelin receptor antagonists or phosphodiesterase type‐5 inhibitors

Frantz, Robert P.; Hill, Jerrold; Lickert, Cassandra A.; Wade, Rolin L.; Cole, Michele; Tsang, Yuen; Drake, William

doi:10.1177/2045894019880086

Cited by 25 publications

(43 citation statements)

References 34 publications

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“…High costs or co-payments for treatment and healthcare have been shown to contribute to poor medication adherence [ 17 , 27 ]. However, in the present study there was no relation between socioeconomic factors and adherence, despite the household income being at, or slightly lower than, the average disposable income in Sweden.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic treatment (≥3 filled prescriptions/year) Angiotensin converting enzyme inhibitors 108 (19) 81 2127 (14) Angiotensin-receptor blockers 101 (18) 65 (17) 36 (19) Beta Asthmainhaler therapy 171 (30) 119 (31) 52 (28) Anti-diarrheal drugs 79 (14) 62 (16) 17 (9) Anti-emetics 61 (11) 52 (14) 9 (5) Anti-acid drugs 47 (8) 41 (11) 6 (3)…”

Section: All Pah Cteph N=571 N=384 N=187mentioning

confidence: 99%

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Adherence to disease-specific drug treatment among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension

et al. 2020

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BackgroundPulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) require lifelong treatment. The aim of the present study was to investigate adherence to disease specific treatment in patients with PAH or CTEPH.MethodsThe study comprised an adult population diagnosed with PAH (n=384) or CTEPH (n=187) alive in 2016–2017. The study utilised three registries; the Swedish PAH registry, the National Board of Health and Welfare and, Statistics Sweden. Withdrawals from pharmacies of disease-specific oral treatments were studied. Adherence was assessed as; 1) Number of days covered defined as the difference between the total number of daily dosages dispensed and the total number of days covered and 2) Manual assessment by two persons that independently reviewed each patient's prescription fill history to detect anomalies or patterns of deteriorating or improving adherence over time.ResultsThe mean age was 61±16 years, 61% were female and mean time since diagnosis was 4.6 years. Adherence was 62% using the Number of days covered method and 66% by the Manual assessment method. Drug specific adherence varied from 91% for riociguat to 60% for sildenafil. Good adherence was associated to shorter time since diagnosis in patients with PAH and to lower number of concomitant other chronic treatments in patients with CTEPH. Age, sex, socioeconomic status, or number of PH-treatments were not associated to adherence.ConclusionAdherence to oral disease specific treatment was 60–65% and associated to time since diagnosis and number of concomitant chronic treatments. Sex, age or socioeconomic factors did not affect adherence.

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Section: Discussionmentioning

confidence: 99%

Section: All Pah Cteph N=571 N=384 N=187mentioning

confidence: 99%

Adherence to disease-specific drug treatment among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension

et al. 2020

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“…So far, several lines of evidence have strongly suggested that targeting the NO pathway might be the strategy with the most potential. A recent investigation also found that higher adherence to PDE5 in patients with PAH is associated with a lower risk of hospitalization and rehospitalization (48). Therefore, we suggest the following for further research: (I) conducting high-quality studies at the recommended dose of 20 mg/TID; (II) trials should measure outcomes which are clinically relevant (e.g., mortality, quality of life, and clinical worsening) so that the long-term effects can be established; and (III) attach importance to the real-world data and evaluation of pharmacoeconomics.…”

Section: Discussionmentioning

confidence: 91%

Sildenafil for adult Asian patients with pulmonary arterial hypertension: a systematic review and meta-analysis

Shi¹,

Wang²,

Yang³

et al. 2022

Ann Palliat Med

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Background: The prognosis of patients with untreated pulmonary arterial hypertension (PAH) has historically been poor. Previous studies have recommended that sildenafil was beneficial, but the dose varies greatly. In this study, we aimed to evaluate the safety and effectiveness of sildenafil [dose: 20 mg/three times a day (TID)] for adult Asian PAH patients.Methods: Electronic databases (MEDLINE, Embase, Web of Science, the Cochrane Library, CBM, CNKI, and Wanfang Data) were searched from their inception to January 2022. We recruited all randomized controlled trials and non-randomized studies of interventions that compared sildenafil (20 mg/TID) versus placebo or symptomatic treatment for adult Asian PAH patients.Results: A total of 10 studies involving 480 participants were included. Compared to symptomatic treatment, sildenafil-treated patients were more likely to walk 57.68 meters further in six-minute walk distance [mean difference (MD) =57.68 m, 95% confidence interval (CI): 41.55 to 73.81], achieve an improvement in systemic arterial oxygen saturation (MD =2.48%, 95% CI: 1.26 to 3.71), and increase the score of the Borg scale for dyspnea (MD =−0.99 points, 95% CI: −1.45 to −0.53). The total number of patients with World Health Organization class III and IV also exhibited a downtrend. Compared to the placebo, sildenafil was associated with a reduction in the mean pulmonary artery pressure (MD =−4.13 mmHg, 95% CI: −6.52 to −1.74) and the level of brain natriuretic peptide (MD =−86.16 pg/mL, 95% CI: −103.39 to −68.93). The most common adverse events were headache, flushing, dyspepsia, and diarrhea, which were relatively mild.Discussion: Sildenafil at a dose of 20 mg/TID is well tolerated in adult Asian PAH patients, and is associated with statistically significant improvements in exercise capacity, cardio-pulmonary function, and haemodynamic indices. The long-term prognosis still needs to be evaluated and confirmed by further trials.

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“…Individuals were considered adherent if they achieved PDC ≥80%, a standard threshold for pharmacologic adherence in PAH and other conditions. 24 , 25 Those using combination therapy were not included in adherence analyses for ERAs or PDE5.…”

Section: Methodsmentioning

confidence: 99%

Association Between Copayment and Adherence to Medications for Pulmonary Arterial Hypertension

Schikowski

Swabe

Chan

et al. 2022

JAHA

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Background Pharmacologic treatment for pulmonary arterial hypertension (PAH) improves exercise capacity, functional class, and hemodynamic indexes. However, monthly prescription costs often exceed $4000. We examined associations between (1) medication copayment and (2) annual household income with adherence to pulmonary vasodilator therapy among individuals with PAH. Methods and Results We used administrative claims data from an insured population in the United States to identify individuals diagnosed with PAH between 2015 and 2020. All individuals had ≥1 medication claim for endothelin receptor antagonists, phosphodiesterase type‐5 inhibitors, prostanoids or prostacyclin receptor agonists, or the soluble guanylate cyclase stimulator riociguat. We defined copayments as low, medium, or high, as determined by their distributions for each medication class. Annual household income was categorized as <$40 000, $40 000 to $74 999, and ≥$75 000. The primary outcome was medication adherence, defined by proportion of days covered ≥80%. We studied 4025 adults (aged 65.9±13.3 years; 71.2% women). Compared with those with annual household income ≥$75 000, individuals in the <$40 000 and $40 000 to $74 999 categories had no significant differences in medication adherence. Compared with those with low copayments, individuals with high copayments had decreased adherence to prostanoids (odds ratio [OR], 0.36 [95% CI, 0.20–0.65]; P <0.001) and combination therapy with endothelin receptor antagonist and phosphodiesterase type‐5 inhibitor (OR, 0.61 [95% CI, 0.38–0.97]; P =0.03). Conclusions We identified associations between copayment and adherence to prostanoids and combination therapy among individuals with PAH. Copayment may be a structural barrier to medication adherence and merits inclusion in studies examining access to pharmacotherapy among individuals with PAH.

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Medication adherence, hospitalization, and healthcare resource utilization and costs in patients with pulmonary arterial hypertension treated with endothelin receptor antagonists or phosphodiesterase type‐5 inhibitors

Cited by 25 publications

References 34 publications

Adherence to disease-specific drug treatment among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension

Adherence to disease-specific drug treatment among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension

Sildenafil for adult Asian patients with pulmonary arterial hypertension: a systematic review and meta-analysis

Association Between Copayment and Adherence to Medications for Pulmonary Arterial Hypertension

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