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Abstract
Objectives:
To determine whether amlodipine/valsartan/hydrochlorothiazide single pill combination (SPC) is associated with improved persistence, adherence and reduced healthcare utilization and costs compared to the corresponding free combination (FC).
Methods:
Adult (≥18 years) patients covered by commercial and Medicare Supplemental insurance in the Truven MarketScan database with hypertension (HTN) diagnosis between October 2009 and December 2011 were included. At least two filled prescriptions for the SPC cohort or two periods of minimum 15 days of concurrent use of amlodipine, valsartan and hydrochlorothiazide (HCT) for the FC cohort were required. Cohorts were propensity score matched (PSM) to balance on important confounders. Outcomes included: 1) adherence (proportion of days covered [PDC] and medication possession ratio [MPR]); 2) persistence (treatment gap >30 days); 3) all-cause and HTN-specific healthcare utilization and costs at 12 months.
Results:
After cohort matching with PSM, patients taking SPC (N = 9221) exhibited better outcomes than FC (N = 1884): higher mean adherence (85.7% vs. 77.0%), mean PDC (73.8% vs. 60.6%) and persistence (46.8% vs. 23.6%) (all p < 0.0001). Patients taking SPC were associated with higher odds of persistence (OR: 3.51; 95% CI: 3.08–4.02), MPR ≥80% (OR: 2.72; 95% CI: 2.40–3.08) and PDC ≥80% (OR: 2.88; 95% CI: 2.55–3.26). After PSM, the SPC cohort exhibited statistically significantly lower mean number of resource utilization events compared to FC. Patients in the SPC cohort also had a statistically significantly (p < 0.05) lower percentage of patients with ≥1 all-cause hospitalization (15.0% vs. 18.2%), ≥1 all-cause emergency room (ER) visits (25.7 vs. 31.4%), and ≥1 ER HTN-specific visits (9.7% vs. 14.1%). The costs incurred by SPC cohort patients were 2.8% to 41.7% numerically lower than the FC cohort, statistically significant for all-cause ER costs ($430.6 vs. $549.5, p < 0.05).
Conclusions:
Real-world data indicate an association of the amlodipine/valsartan/HCT SPC with improved adherence and persistence vs. FC with no difference in overall healthcare or hypertension specific costs between the cohorts.
Transparency
Declaration of funding
This project was funded by Novartis Pharma AG.
Declaration of financial/other relationships
S.H.O. has disclosed that she is an employee of Novartis Pharma AG, Basel. G.M. has disclosed that he is an employee of Janssen Latin America, Buenos Aires, Argentina and at the time of this study was an employee of Novartis Argentina SA. W.C. and Z.J.W. have disclosed that they are employees of Novartis Pharma Co. Ltd, Shanghai. K.H.K. has disclosed that he is an employee of Novartis Pharmaceuticals Corporation, NJ, USA.
CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgments
The authors thank Samprati Avasthi (Novartis) for assistance with write-up of the manuscript and Ashwani Kumar (Novartis) for critical review of the manuscript.