Effect of medication burden on persistent use of lipid-lowering drugs among patients with hypertension.
OBJECTIVE
To determine the effect of medication burden on persistent use of newly added lipid-lowering (LL) drugs among patients with hypertension.


METHODS
This retrospective database study used medical and pharmacy claims from a mid-Atlantic managed care organization. The cohort was obtained from continuous member enrollment in pharmacy and medical benefits from January 1, 2003, to December 31, 2005.


METHODS
Prescription claims were obtained for 18 months following the date of the first filled LL prescription (ie, index date). Patients were stratified into patients who changed LL drug or strength (group 1) and patients who did not change LL drug or strength (group 2). The primary outcome measure was persistence to newly added LL therapy. Persistence was defined by the length of time a member remained on therapy following the index date. The secondary outcome measure was the medication possession ratio (MPR). The MPR was calculated as the ratio of the sum of the days' supply of prescription filled divided by the number of days filled, plus the days' supply for the final prescription fill. Associations between the daily medication burden, defined as the number of unique drug products, and the outcome measures were analyzed.


RESULTS
In the cohort of 3058 patients, the mean medication burden was 2.9 medications. Medication burden was positively associated with persistence and MPR through 18 months. Patients who had greater medication burden had longer persistence (P <.001). Likewise, patients who had greater medication burden had higher MPRs and were more likely to be considered adherent (MPR, >80%) (P < .001 for both).


CONCLUSIONS
Patients with higher medication burden had greater adherence to newly added LL therapy. Medication burden should not deter clinicians from adding LL therapy. Among patients with added LL therapy, more attention should focus on patients who have changes to their LL regimen compared with patients who continue on the same LL prescription.
Robertson
Teisha A
TA
School of Pharmacy, University of Maryland, Baltimore, MD, USA. ttay1002@umaryland.edu
Cooke
Catherine E
CE
Wang
Jingshu
J
Shaya
Fadia T
FT
Lee
Helen Y
HY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D050171:Dyslipidemias / Q000188:drug therapy* / Q000378:metabolism*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000378:metabolism*; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D055815:Young Adult
D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents