title: Cardiovascular-related healthcare resource utilization and costs in patients with hypertension switching from metoprolol to nebivolol.
abstract: BACKGROUND
  The prevalence of hypertension is increasing in the United States and the associated costs are soaring. Despite the many treatment options, only approximately 50% of Americans with hypertension achieve optimal control. Patients receiving nebivolol, a third-generation beta-blocker, have fewer adverse events and better treatment persistence compared with patients receiving other antihypertensive agents. Little is known about the impact of switching from a second-generation beta-blocker, such as metoprolol, to nebivolol on healthcare resource utilization and costs.
  
  
  OBJECTIVE
  To assess the impact of switching patients with hypertension from metoprolol to nebivolol on the associated healthcare resource utilization and cost.
  
  
  METHODS
  This retrospective claims-based analysis included 765 adults aged ≥18 years who were diagnosed with hypertension between January 1, 2008, and December 31, 2012. Data were extracted from the HealthCore Integrated Research Database; the study was conducted between July 1, 2007, and June 30, 2013. To be included in the study, patients had to receive metoprolol for ≥6 months before switching from metoprolol to nebivolol (the preperiod), and continue to use nebivolol for an additional 6 months after switching (the postperiod). Patients with compelling indications for metoprolol but not for nebivolol were excluded from the study. The primary outcome measures were healthcare resource utilization and costs for cardiovascular (CV)-related events. The CV-related resource utilization was calculated based on 100 patients per month; the CV-related costs were calculated per patient per month (PPPM) in 2013 US dollars.
  
  
  RESULTS
  A total of 765 patients were included in the analysis. Compared with the preperiod, patients switching to nebivolol had significantly fewer CV-related emergency department visits (0.2 [standard deviation (SD), 1.9] vs 0.04 [SD, 0.8], respectively; P = .012) and fewer CV-related outpatient visits (9.2 [SD, 19.9] vs 6.7 [SD, 17.5], respectively; P <.001). The numbers of inpatient visits in the preperiod and postperiod were similar (0.3 [SD, 2.4] vs 0.1 [SD, 1.5], respectively; P = .164). Patients switching to nebivolol also had significantly lower CV-related emergency department costs ($6 [SD, $78] vs $1 [SD, $27] PPPM, respectively; P = .028) and lower CV-related total medical costs ($94 [SD, $526] vs $54 [SD, $266] PPPM, respectively; P = .020).
  
  
  CONCLUSIONS
  This analysis of real-world data suggests that patients with hypertension who switch from the second-generation antihypertensive metoprolol to the third-generation hypertensive nebivolol have significantly lower CV-related healthcare resource utilization (eg, emergency department and outpatient visits) and lower CV-related medical costs.
authors.affiliation: Associate Director, Health Economics and Outcomes Research, Forest Research Institute, Inc, Jersey City, NJ, when this study was conducted.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chen
authors.affiliation: Senior Research Analyst, HealthCore, Inc, Wilmington, DE.
authors.forename: An-Chen
authors.initials: AC
authors.lastname: Fu
authors.affiliation: Research Manager, HealthCore, Inc, Wilmington, DE.
authors.forename: Rahul
authors.initials: R
authors.lastname: Jain
authors.affiliation: Director, HealthCore, Inc, Wilmington, DE.
authors.forename: Hiangkiat
authors.initials: H
authors.lastname: Tan
keywords: cardiovascular events; healthcare resource utilization; hypertension; metoprolol; nebivolol