Pharmacy & Therapeutics - November 2008 - (Page 660)

Switching from Fixed-Dose to Free-Combination Antihypertensive Medications continued from page 654 Table 1 Demographics and Comorbidities for Patients Receiving Fixed-Dose Combination (FDC) and Free-Combination (FC) Antihypertensive Medications FC: Commercial (n = 4,109) Mean Age 53.32 Months on 8.45 FDC prior to index date Sex Female Male No. 2,117 1,992 SD (7.39) (5.73) FDC: Commercial (n = 4,108) Mean 52.88 8.59 SD (7.35) (5.81) FC: Medicare (n = 3,116) Mean 75.44 8.47 SD (6.88) (5.74) FDC: Medicare (n = 3,116) Mean 74.16 8.67 SD (6.60) (5.62) FC: Total (n = 7,225) Mean 62.86 8.46 SD (13.10) (5.73) FDC: Total (n = 7,224) Mean 62.06 8.63 SD (12.67) (5.79) % 51.52% 48.48% No. 2,117 1,991 % 51.53% 48.47% No. 1,997 1,119 % 64.09% 35.91% No. 1,993 1,123 % 63.96% 36.04% No. 4,114 3,111 % 56.94% 43.06% No. 4,110 3,114 % 56.89% 43.11% Presence of risk factors (measured six months prior to index date)* Congestive 9 heart failure COPD 11 Diabetes 171 Lipid 101 disorder Myocardial infarction 18 Tobacco use 1 0.22% 0.27% 4.16% 2.46% 13 11 170 101 0.32% 0.27% 4.14% 2.46% 39 31 108 42 1.25% 0.99% 3.47% 1.35% 49 32 105 43 1.57% 1.03% 3.37% 1.38% 48 42 279 143 0.66% 0.58% 3.86% 1.98% 62 43 275 144 0.86% 0.60% 3.81% 1.99% 0.44% 0.02% 14 1 0.34% 0.02% 20 1 0.64% 0.03% 9 2 0.29% 0.06% 38 2 0.53% 0.03% 23 3 0.32% 0.04% * Risk factors were measured in the six-month interval prior to index date using ICD-9-CM diagnoses codes from claims data. COPD = chronic obstructive pulmonary disease; SD = standard deviation. patients who were switched to FC therapy. The FDC–FC difference was slightly greater for the Medicare patients than for the commercial group (see Table 2). For the total sample, compliance rates were 76.9% for FDC and 54.4% for FC; for commercial coverage, 74.9% for FDC and 55.4% for FC; and for Medicare coverage, 79.4% for FDC and 52.9% for FC (P < 0.001 for all contrasts) (see Table 2 for unadjusted rates). Regression-adjusted differences in compliance for FDC, compared with FC, were 22.1% for the total sample, 19.3% for commercial patients, and 25% for Medicare patients (P < 0.001 for all contrasts) (see Table 2 for regression-adjusted differences). Unadjusted hypertension-related expenditures in the total sample were $657 for FC and $469 for FDC (P = 0.012) for hypertension-related services and $1,424 for FC and $1,139 for FDC (P = 0.001) for total hypertension-related health care (services and medications). Unadjusted hypertension-related expenditures were also significantly higher for FC patients than for FDC patients in the commercial sample, but they were not significantly higher in the Medicare sample (see Table 3). Impact of Compliance on Health Care Costs Regression-adjusted estimates of the relationship between medication compliance and utilization and expenditures for hypertension-related health care show decreased usage as compliance increased (Table 4). All differences between FDC and FC regimens were statistically significant except for the percentage of Medicare patients making a hypertensionrelated office visit. The results imply that the higher compliance rates for FDC were associated with lower utilization of and expenditures for hypertension-related services for FDC patients. For instance, in the total sample, each 10-percentage point increase in the compliance rate was associated with a 0.3% reduction in the number of commercially insured patients hospitalized for hypertension (see Table 4) or a 0.03% reduction for each percentage point increase in compliance. Because compliance for Health Care Utilization and Costs Unadjusted utilization and expenditures for hypertensionrelated health care were higher for the FC cohorts, although some differences between Medicare cohorts were not significant (Table 3). The percentages of patients receiving health care services for a primary diagnosis of hypertension in the total sample were as follows: for inpatient services, 3.11% with FC and 2.45% with FDC (P = 0.016); for emergency department visits, 1.72% with FC and 0.82% with FDC (P = 0.001); and for office visits, 65.81% with FC and 59.39% with FDC (P = 0.001). The percentage of patients using hypertension-related services was also higher for FC in the commercial and Medicare samples; however, the difference in rates for inpatient services was not significant in the Medicare sample (see Table 3). 660 P&T® • November 2008 • Vol. 33 No. 11

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - November 2008

Pharmacy & Therapeutics - November 2008 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/New Medical Devices Drug Forecast Heparin-Induced Thrombocytopenia Medication Utilization Patterns and Hypertension-Related Expenditures among Patients Who Were Switched From Fixed-Dose to Free-Combination Antihypertensive Therapy European Society for Medical Oncology and Association for the Study of Bone and Mineral Research Pharmaceutical Approval Update

Pharmacy & Therapeutics - November 2008

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