Pharmacoeconomics of Antihypertensive Drug Treatment: An Analysis of How Long Patients Remain on Various Antihypertensive Therapies

Esposti, Luca Degli; Martino, Mirko Di; Saragoni, Stefania; Sgreccia, Andrea; Capone, Alessandro; Buda, Stefano; Esposti, Ezio Degli

doi:10.1111/j.1524-6175.2004.03044.x

Cited by 65 publications

(71 citation statements)

References 32 publications

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“…We also assessed whether the predictors of persistence (age, gender, type of insurance, type of first prescriber, type of first antihypertensive, type of cardiovascular hospitalization prior to the study entrance, and comedication) differed, between and within the three different methods using Cox proportional hazard analysis with backward elimination. [8,21,22] We observed differences in predictors of 1-year persistence in the final models between the definitions. Age, first prescriber, type of first antihypertensive, and hospitalization for ischemic heart disease prior to study entrance were significantly associated with 1-year persistence in all models of all three definitions (data not shown).…”

Section: Resultsmentioning

confidence: 82%

Refill persistence with chronic medication assessed from a pharmacy database was influenced by method of calculation

Wijk¹,

Klungel²,

Heerdink³

et al. 2006

Journal of Clinical Epidemiology

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Background and Objectives: In literature, different methods of calculating persistence are used. In this study, the effect of using these different methods on persistence and the association of patients characteristics and persistence are assessed.Methods: The PHARMO record linkage system was used to calculate persistence with antihypertensive drugs for a cohort of 14,466 new users of antihypertensives. Three different types of methods were used to define the maximum gap allowed between two prescriptions that a patient may have to be defined as a continuous user, one based on a defined number of days (varying from 9-365 days), the second based on the duration of the last prescription (varying from 0.1-4 times the duration), the third based on a combination of both methods, whichever leads to the lowest number of days.Results: Refill persistence varied between 19.7-86.4% (method 1), between 27.9-90.2% (method 2), and between 19.7-86.4% (method 3). Furthermore, patient characteristics associated with persistence differed between and within the three different methods.Conclusion: The method used and the variation within a method influenced both persistence and the association between patient characteristics and persistence. Results of persistence studies are highly influenced by the researchers' method of the maximum allowed treatment gap. Ó

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Section: Resultsmentioning

confidence: 82%

Refill persistence with chronic medication assessed from a pharmacy database was influenced by method of calculation

Wijk¹,

Klungel²,

Heerdink³

et al. 2006

Journal of Clinical Epidemiology

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“…As many as 60% of hypertensive patients discontinue their treatment within the first year of care (70)(71)(72), and fewer than 65% remain in therapy after three years (72,73). Of those remaining in treatment, antihypertensive medication adherence varies from 40% to 70% (74)(75)(76).…”

Section: Discussionmentioning

confidence: 99%

Take Control of Your Blood pressure (TCYB) study: A multifactorial tailored behavioral and educational intervention for achieving blood pressure control

Bosworth

Olsen

Neary

et al. 2008

Patient Education and Counseling

141

124

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Objectives-Evaluating a randomized controlled trial involving a tailored behavioral intervention conducted to improve blood pressure control.Methods-Adults with hypertension from two outpatient primary care clinics were randomly allocated to receive a nurse-administered behavioral intervention or usual care. In this ongoing study, patients receive the tailored behavioral intervention bi-monthly for two years via telephone; the goal of the intervention is to promote medication adherence and improve hypertension-related health behaviors. Patient factors targeted in the tailored behavioral intervention include perceived risk of hypertension and knowledge, memory, medical and social support, patients' relationship with their health care provider, adverse effects of medication therapy, weight management, exercise, diet, stress, smoking, and alcohol use.Results-The sample randomized to the behavioral intervention consisted of 319 adults with hypertension (average age = 60.5 years; 47% African-American). A comparable sample of adults was assigned to usual care (n=317). We had a 96% retention rate for the overall sample for the first 6 months of the study (93% at 12 months). The average phone call has lasted 18 minutes (range 2 to 51 minutes). From baseline to six months, self-reported medication adherence increased by 9% in the behavioral group vs. 1% in the non-behavioral group.Conclusion-The intervention is easily implemented and is designed to enhance adherence with prescribed hypertension regimen. The study includes both general and patient-tailored information based upon need assessment. The study design ensures internal validity as well as the ability to generalize study findings to the clinic settings. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Practice Implications-Despite knowledge of the risks and acceptable evidence, a large number of hypertensive adults still do not have their blood pressure under effective control. This study will be an important step in evaluating a tailored multibehavioral intervention focusing on improving blood pressure control. NIH Public Access

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“…[27][28][29] In a Medicaid population, continuous use of antihypertensive medications in the first year after initiation was associated with significantly lower health care costs, mainly attributable to decreased hospital expenditures. 30 We conducted a study in a large patient population to assess patient persistence, adherence, and treatment discontinuation over 1 year among patients treated with the most widely prescribed antihypertensive agent in each of 4 drug classes at the time the study was conducted: thiazide-type diuretics (hydrochlorothiazide, HCTZ); CCBs (amlodipine); ACE inhibitors (lisinopril); and ARBs (valsartan).…”

mentioning

confidence: 99%

Persistence, Adherence, and Risk of Discontinuation Associated with Commonly Prescribed Antihypertensive Drug Monotherapies

Elliott¹,

Plauschinat²,

Skrepnek³

et al. 2007

The Journal of the American Board of Family Medicine

123

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Measurements: Drug utilization following initiation. Cox proportional hazards regression models controlled for demographics, case-mix, and concomitant treatments.Results: Records for 60,685 subjects were included: HCTZ (n ‫؍‬ 18,713), amlodipine (n ‫؍‬ 11,520), lisinopril (n ‫؍‬ 21,138), or valsartan (n ‫؍‬ 9314). Over 1 year, 31% to 44% of subjects utilized no treatment for at least 60 days. Medication possession ratio (MPR) and adherence measures ranged from 73% to 90%. Valsartan was associated with significantly (P < .001) more favorable measures of persistence, length of therapy, time to discontinuation, MPR, and risk of discontinuation, compared with HCTZ, amlodipine, or lisinopril. The risk of discontinuation was 53%, 32%, and 14% greater for HCTZ, amlodipine, and lisinopril, respectively, versus valsartan (all comparisons P < .001). Conclusion: Among antihypertensive agents studied, valsartan was associated with the most favorable utilization patterns. Health care providers and systems should evaluate the use of antihypertensive drugs within their populations to identify and manage treatment discontinuation. (J Am Board Fam Med 2007;20:72-80.)Hypertension is a common and eminently treatable risk factor for major cardiovascular events, including coronary heart disease and stroke.1 Cardiovascular disease is the leading cause of morbidity and mortality in developed nations, 2 and is expected to increase in worldwide importance during the next 20 to 50 years. 3 The prevalence of hypertension seems to be increasing in both developed nations, where it currently affects approximately 1 in 3 adults, 4 and in developing countries. 5Meta-analyses and meta-regression analyses of clinical trials in hypertension have reported that pharmacologic drug therapy significantly reduces cardiovascular events, which is largely attributable This article was externally peer reviewed.

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Pharmacoeconomics of Antihypertensive Drug Treatment: An Analysis of How Long Patients Remain on Various Antihypertensive Therapies

Cited by 65 publications

References 32 publications

Refill persistence with chronic medication assessed from a pharmacy database was influenced by method of calculation

Refill persistence with chronic medication assessed from a pharmacy database was influenced by method of calculation

Take Control of Your Blood pressure (TCYB) study: A multifactorial tailored behavioral and educational intervention for achieving blood pressure control

Persistence, Adherence, and Risk of Discontinuation Associated with Commonly Prescribed Antihypertensive Drug Monotherapies

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