ClinicoEconomics and Outcomes Research (Jul 2010)

Antihypertensive therapy among newly treated patients: An analysis of adherence and cost of treatment over years

  • Luca Degli Esposti,
  • Stefania Saragoni,
  • Paolo Batacchi,
  • et al

Journal volume & issue
Vol. 2010, no. default
pp. 113 – 120

Abstract

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Luca Degli Esposti1, Stefania Saragoni1, Paolo Batacchi2, Pierangelo Geppetti3, Stefano Buda1, Ezio Degli Esposti41CliCon S.r.l., Health, Economics and Outcomes Research, Ravenna; 2Pharmaceutical Policy Department, Local Health Unit of Florence; 3Department of Preclinical and Clinical Pharmacology, University of Florence; 4Outcomes Research Unit, Policlinics Umberto I, Rome, Italy.Objective: To perform a time-trend analysis of adherence and cost of antihypertensive ­treatment over four years.Methods: A population-based retrospective cohort study was conducted. We included subjects ≥18 years, and newly treated for hypertension with diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers between 01 January 2004 and 31 December 2007. One-year adherence to antihypertensive therapy was calculated and classified as low, low-intermediate, intermediate, high-intermediate, and high. The direct cost of antihypertensive medications was evaluated.Results: We included data for a total of 105,512 patients. The number of newly treated subjects decreased from 27,334 in 2004 to 23,812 in 2007, as well as antihypertensive drug therapy cost which decreased from €2,654,166 in 2004 to €2,343,221 in 2007. On the other hand, in the same time frame, the percentage of adherent newly treated subjects increased from 22.9% to 28.0%. Compared with subjects initiated on angiotensin receptor blockers (odds ratio [OR] = 1), the risk of nonadherence was higher in those initiated on angiotensin-converting enzyme inhibitors (OR = 1.19), combination therapy (OR = 1.44), beta-blockers (OR = 1.56), calcium channel blockers (OR = 1.67), and diuretics (OR = 4.28).Conclusions: The findings of the present study indicate that suboptimal adherence to antihypertensive medication occurs in a substantial proportion of treated patients, and improvements in treatment adherence were obtained but are still unsatisfactory.Keywords: antihypertensive therapy, adherence, cost, administrative databases.