The Costs of Interrupting Antihypertensive Drug Therapy in a Medicaid Population

McCombs, Jeffrey S.; Nichol, Michael B.; Newman, Cecelia M.; Sclar, David A.

doi:10.1097/00005650-199403000-00003

Cited by 158 publications

(98 citation statements)

References 17 publications

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“…4,[33][34][35] Switching and discontinuation have also been shown to increase the costs of hypertension. 32,34,36,37 Our study constitutes a 'real world' insight into persistence and utilization of health-care resources in a population-based clinical hypertension cohort. Nonetheless, results should be considered in light of the study limitations.…”

Section: Discussionmentioning

confidence: 99%

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Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

et al. 2005

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The objective was to assess persistence with antihypertensive therapy (AHT) and discontinuation patterns in patients newly dispensed different antihypertensive drug classes in a natural Canadian population-based setting. Hypertensive patients initiating AHT monotherapy were included in this 3-year retrospective cohort study (N ¼ 21 326) using the Saskatchewan health-care databases. Persistence was defined as consistently refilling a new prescription for AHT within 90 days of a previous dispensing. New courses of AHT were also documented in nonpersistent patients. Kaplan-Meier and Cox regression analyses were used to compare persistence and new courses of therapy across initial drugs. Compared to the newer angiotensin II antagonists (AIIAs), the likelihood of discontinuing therapy over the 39-month study period was significantly higher for angiotensin-converting enzymes inhibitors (HR ¼ 1.29; 95% CI ¼ 1.16-1.43), calcium channel blockers (HR ¼ 1.42; 95% CI ¼ 1.27-1.60), beta blockers (HR ¼ 1.62; 95% CI ¼ 1.45-1.80) and diuretics (HR ¼ 1.92; 95% CI ¼ 1.73-2.14). In the year following treatment discontinuation, between 54 and 75% of patients initiated a second course of treatment. Patients initiated on an AIIA had a significantly higher likelihood of starting a new course of therapy after a first treatment discontinuation, compared to all other agents. In conclusion, hypertensive patients initiated on an AIIA not only had greater persistence to AHT but were also more likely to initiate a new course of AHT after discontinuation than those initiating treatment with other agents. Further studies are required that relate intermittent treatment behaviours to health outcomes and costs in hypertension.

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Section: Discussionmentioning

confidence: 99%

“…In addition to hindering disease control, lack of persistence with therapy may entail substantial health-care resources. [12][13] Numerous studies have examined treatment persistence in hypertension. Some of these predated the introduction of newer drug classes such as the angiotensin II antagonists (AIIAs).…”

Section: Introductionmentioning

confidence: 99%

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

et al. 2005

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“…[14][15][16][17][18] 19 Such studies of associations between medication adherence and various outcomes-including mortality, hospitalization, and health care expenditures-have become familiar fare to managed care decision makers. [20][21][22][23][24][25][26] Typically consisting of retrospective analyses of administrative claims data, almost always with statistical adjustments for measured confounders, these studies routinely find that higher rates of medication adherence are associated with better outcomes and lower disease-related or all-cause health care cost. [20][21][22][23][24][25][26] These associations between adherence and improved health outcomes are often cited in assessments of various treatments that increase pharmacy benefit spending, such as newer products with less frequent dosing 22,27 or fixed-dose single-pill combinations containing drugs available individually as generic drugs.…”

Section: E D I T O R I a Lmentioning

confidence: 99%

“…[20][21][22][23][24][25][26] Typically consisting of retrospective analyses of administrative claims data, almost always with statistical adjustments for measured confounders, these studies routinely find that higher rates of medication adherence are associated with better outcomes and lower disease-related or all-cause health care cost. [20][21][22][23][24][25][26] These associations between adherence and improved health outcomes are often cited in assessments of various treatments that increase pharmacy benefit spending, such as newer products with less frequent dosing 22,27 or fixed-dose single-pill combinations containing drugs available individually as generic drugs. 20,21,28 The objective of this type of assessment is, of course, to suggest that if the payer is willing to adopt the new product, the increased prescription drug expense potentially could be partly or fully offset by reductions in total medical cost.…”

Section: E D I T O R I a Lmentioning

confidence: 99%

“…[20][21][22][23][24][25][26] These associations between adherence and improved health outcomes are often cited in assessments of various treatments that increase pharmacy benefit spending, such as newer products with less frequent dosing 22,27 or fixed-dose single-pill combinations containing drugs available individually as generic drugs. 20,21,28 The objective of this type of assessment is, of course, to suggest that if the payer is willing to adopt the new product, the increased prescription drug expense potentially could be partly or fully offset by reductions in total medical cost. 27,28 Similarly, a recent "prescription for national healthcare reform" cited associations of adherence with lower total health care cost in making the case that $177 billion could be saved annually in the United States by improving adherence to prescribed medication and reducing medication-taking errors.…”

Section: E D I T O R I a Lmentioning

confidence: 99%

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Still Looking for Health Outcomes in All the Wrong Places? Misinterpreted Observational Evidence, Medication Adherence Promotion, and Value-Based Insurance Design

Fairman¹,

Curtiss²

2009

JMCP

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Above all, the right question needs to be framed."1 To those who would argue that sophisticated statistical modeling obviates the need to consider confounding factors and alternative explanations when interpreting observational associations, Freedman's answer was simple: "The technology is relatively easy to use. … However, the appearance of methodological rigor can be deceptive."1 More contemporary guidelines for research reporting acknowledge the same understanding: when interpreting associations, multivariate modeling is often appropriate and valuable, but is still potentially vulnerable to the effects of confounding and bias and is therefore no substitute for a randomized design. 2,3,4 Lessons Learned From Confusing Association With Causation in Chasing BiomarkersCurtiss and Fairman observed in the July/August 2008 issue of JMCP that "evidence-based" interventions targeted to biomarkers frequently do not produce the end point "outcomes we love," such as reductions in hospitalization rates or mortality.5 Notably, most of the instances cited were characterized by a single common pattern: the usurping of lower-quality evidence based on observational associations with higher-quality evidence garnered from experimental testing of hypothesized causal factors.For example, the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial was conducted because observational research had documented associations of blood glucose and HbA1c (A1c) levels with cardiovascular events. Researchers randomized 11,140 patients with type 2 diabetes to standard glucose control or intensive glucose control, targeted to achieve an A1c level of 6.5% or less.6 During a median 5 years of follow-up, the patients randomized to the intensive glucose control intervention did not have a significantly lower risk of major macrovascular events (hazard ratio [HR] = 0.94, 95% confidence interval [CI] = 0.84-1.06), cardiovascular mortality (HR = 0.88, 95% CI = 0.74-1.04), or all-cause mortality (HR = 0.93, 95% CI = 0.83-1.06), but did have an increased risk of severe hypoglycemia (2.7% intensive control vs. 1.5% standard control; HR = 1.86, 95% CI = 1.42-2.40). Similarly, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was initiated because of high-quality prospective observational evidence suggesting that after "adjusting for other risk factors," each 1% decrease in A1c was associated with a 21% decrease in the risk of diabetes-related mortality, a 14% decrease Naturally, there is a strong desire to substitute intellectual capital for labor. That is why investigators often try to base causal inference on statistical models.

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Automated Outreach to Increase Primary Adherence to Cholesterol-Lowering Medications

Derose

Green²,

Marrett³

et al. 2013

JAMA Intern Med

103

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The Costs of Interrupting Antihypertensive Drug Therapy in a Medicaid Population

Cited by 158 publications

References 17 publications

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

Still Looking for Health Outcomes in All the Wrong Places? Misinterpreted Observational Evidence, Medication Adherence Promotion, and Value-Based Insurance Design

Automated Outreach to Increase Primary Adherence to Cholesterol-Lowering Medications

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