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Impact of Therapy Changes From Fixed-Dose Combinations to Free-Agent Ingredient Prescriptions on Persistency and Compliance in Hypertension: Presented at AAFP

By Laura Gater

CHICAGO, IL -- October 9, 2007 -- Differences in compliances between fixed-dose combination (FDC) and free-agent ingredient (FAI) prescriptions' cohort were approximately 10% at the end of one 12-month assessment period, stated Gregory Hess, MD, MBA, Vice President and Chief Medical Officer, and Senior Fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, on October 5, at the American Academy of Family Physicians (AAFP) Scientific Assembly here.

Increased compliance with medications is correlated with reduced healthcare costs and improved outcomes, said Dr. Hess. As a patient's pill burden increases, compliance decreases. This particular study's objective was to evaluate medication compliance of antihypertensive patients who switched from FDC antihypertensives to FAI prescriptions.

Study cohorts were valsartan/hydrochlorothiazide (HCl) (n = 2,432); amlodipine besylate/benazepril HCl (n = 2,662); and other FDC antihypertensives (n = 5,356). FAI and FDC groups were identified.

Dataset from Thomson Medstat MarketScan (R), from January 2003 to December 2005, was analyzed. Patients receiving mail-order medications were excluded from the analysis. The number of patients on FDC was 7,226 and those receiving FAI also numbered 7,226.

Persistence was defined as the percentage of patients not having a lapse in therapy greater than 30 days in a given month following their last day of supply. Compliance was defined as the medical possession ratio (MPR) over 365 days (MPR = total unique days of therapy/365).

Patients in the FDC group showed much better persistency than those in the FAI group at 12 months. The persistency of Medicare patients was also better at FDC at 12 months.

A multivariate analysis of persistence at 12 months was higher for all medications in Medicare patients as well.

The study also found that commercial patients were much more compliant with FDC no matter what type of medications they were taking. This was also true for Medicare patients.

Study limitations were that hypertension disease severity could not be adjusted for in this study and treatment cohorts were not randomized, so internal validity may be limited. The study was limited to the 100+ commercial managed care and Medicare cohorts in the dataset and may not be generalizable to other populations or settings, according to Dr. Hess.

Monthly compliance, persistency, medication refill gaps, and days with therapy were analyzed. At 12 months, the FAI cohorts were less compliant compared with FDC cohorts (range: 40% to 45% vs 65% to 76%). FAI cohorts were also less persistent compared with FDC controls (range: 13% to 15% vs 52% to 57%). The findings were statistically significant (P <.05).

[Presentation title: Impact of Therapy Changes from Fixed Dose Combinations to Free-Agent Ingredient Prescriptions on Persistency and Compliance in Hypertension]

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