title: Copayment level, treatment persistence, and healthcare utilization in hypertension patients treated with single-pill combination therapy.
abstract: OBJECTIVE
  To evaluate the relationship between drug copayment level and persistence and the implications of non-persistence on healthcare utilization and costs among adult hypertension patients receiving single-pill combination (SPC) therapy.
  
  
  METHODS
  Patients initiated on SPC with angiotensin receptor blocker (ARB) + calcium channel blocker, ARB + hydrochlorothiazide, or angiotensin-converting enzyme inhibitors + hydrochlorothiazide were identified in the MarketScan Database (2006-2008). Multivariate models were used to assess copayment level as a predictor of 3-month and 6-month persistence. Three levels of copayment were considered (low: ≤$5, medium: $5-30, high: >$30 for <90-day supply; low: ≤$10, medium: $10-60, high: >$60 for ≥90-day supply). Separate models examined the implications of persistence during the first 3 months on outcomes during the subsequent 3-month period, including utilization and changes in healthcare costs from baseline. National- and state-level outcomes were analyzed.
  
  
  RESULTS
  Analyses of 381,661 patients found significantly lower 3-month and 6-month persistence to therapies with high copayments. Relative to high-copayment drugs, risk-adjusted odds ratios at 3 months were 1.29 (95% confidence interval [CI]: 1.26, 1.32) and 1.27 (95% CI: 1.24, 1.30) for low- and medium-copayment medications, respectively. The strength of the association between copayment and persistence varied across states. Non-persistent patients had significantly more cardiovascular-related hospitalizations (incidence rate ratio [IRR] = 1.36; 95% CI: 1.30, 1.43) and emergency room (ER) visits (IRR = 1.51; 95% CI: 1.43, 1.59) than persistent patients. Non-persistence was associated with significantly larger increases in all-cause medical services cost by $277 (95% CI: $225, $329), but lesser increases in prescription costs by -$81 (95% CI: -$85, -$76).
  
  
  CONCLUSIONS
  Limitations include the possibility of confounding from unobserved factors (e.g., patient income), and the lack of blood pressure data.
  
  
  CONCLUSIONS
  High copayment for SPC therapy was associated with significantly worse persistence among hypertensive patients. Persistence was associated with substantially lower frequencies of hospitalizations and ER visits and net healthcare cost savings.
authors: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
authors: Weiyi
authors: W
authors: Yang
authors: Kristijan H
authors: KH
authors: Kahler
authors: Thomas
authors: T
authors: Fellers
authors: John
authors: J
authors: Orloff
authors: Joanne
authors: J
authors: Chang
authors: Arielle G
authors: AG
authors: Bensimon
authors: Eric Q
authors: EQ
authors: Wu
authors: Chun-Po Steve
authors: CP
authors: Fan
authors: Andrew P
authors: AP
authors: Yu
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D017047:Cost Sharing; D004338:Drug Combinations; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D010349:Patient Compliance
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations