title: Impact of combination therapy on managed care. Based on a presentation by Lisa Latts, MD, MSPH.
abstract: The major objectives of managed care are particularly applicable to hypertension, a very common disease that affects about 30% of the adult population. Although managed care organizations know that adequate blood pressure control has a considerable impact on reducing hypertension-related morbidity and mortality, managed care is, at present, doing a generally poor job of monitoring antihypertensive therapy. One of the major reasons for this is the difficulty in gathering the necessary data from administrative sources; only chart review, which is very costly and very time consuming, can provide the data needed. The value of disease management lies in its capacity to optimize clinical and economic outcomes as well as to improve service and quality of life, using inputs such as cost, time, clinical resources, and patient satisfaction. Disease management programs are instituted because they can lead to improved quality of life and reduced costs. While the focus in managed care has traditionally been on promoting risk modification behavior, providing patient education, and encouraging medication compliance, the treatment of hypertension itself has not been a major focus in most disease management programs. Measuring the effectiveness of the hypertension treatment is, however, one of the proposed measures for the Health Plan Employer Data and Information Set (HEDIS 2000) to profile health plan quality. From a managed care perspective, the potential benefits of combination therapy for hypertension include improved blood pressure control and improved patient compliance as a result of needing fewer pills and experiencing fewer side effects with low-dose therapy. Among the obstacles to combination therapy in the managed care setting are the addition of the combinations onto a formulary and lack of acceptance among physicians. Fixed-dose combination therapy with a calcium channel blocker and an angiotensin-converting enzyme (ACE) inhibitor can potentially reduce pharmacy costs if given to patients who are taking both drugs independently and to patients who are taking a calcium channel blocker but should probably also be taking an ACE inhibitor (e.g., patients with diabetes or congestive heart failure). A mini-pharmacoeconomic analysis based on claims data over a 6-month period from HMO Colorado, a health maintenance organization, shows that switching patients on dual therapy with a calcium channel blocker and an ACE inhibitor to 1-pill combination therapy with both agents can result in substantial cost savings.
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000191:economics*; D017281:Cost of Illness; D019468:Disease Management; D016527:Drug Costs / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005569:Formularies as Topic; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008329:Managed Care Programs / Q000191:economics*; D014481:United States
chemical_list: D000959:Antihypertensive Agents