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Daria Putignano,1 Valentina Orlando,1 Valeria Marina Monetti,1 Gaetano Piccinocchi,2 Umberto Maria Musazzi,3 Roberto Piccinocchi,4 Paola Minghetti,3 Enrica Menditto1 1CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy; 2SIMG, Società Italiana di Medicina Generale, Florence, Italy; 3Dipartimento di Scienze Farmaceutiche, Università degli Studi di Milano, Milan, Italy; 4University of Naples Federico II, Naples, ItalyCorrespondence: Valentina OrlandoCIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Via Domenico Montesano 49, Naples 80131, ItalyTel +39 081 678657Fax +39 081 678303Email valentina.orlando@unina.itPurpose: To analyse the pattern of use and cost of antihypertensive drugs in new users in an Italian population, and explore the patient/treatment factors associated with the risk of therapy discontinuation.Patients and methods: In this retrospective study, information was collected from a population-based electronic primary-care database. Persistence with medication use 1 year from therapy initiation was evaluated for each user using the gap method. Each new user was classified according to his/her pattern of use as: “continuer”, “discontinuer” “switching” or “add-on”. A Cox regression model was used to analyse the factors influencing therapy discontinuation. Primary-care costs comprised specialists’ visits, diagnostic procedures and pharmacologic therapies.Results: Among 14,999 subjects included in persistence analyses, 55.1% of cases initially started on monotherapy were classified as discontinuers vs 36.5% of cases taking combination therapy (42.3% vs 32.7%, respectively, for free and fixed combinations, P < 0.01). Old age, high cardiovascular risk and being in receipt of fixed-combination therapy were associated with greater persistence. Overall, the primary-care cost/person/year of hypertension management was ∼€95.3 (IQR, 144.9). The monotherapy cost was €88 per patient (IQR, 132.9), and that for combination therapy was €151±148.3. The median cost/patient with a fixed combination was lower than that for a free combination (€98.4 (IQR, 155.3) and €154.9 (IQR, 182.6), respectively).Conclusion: The initial type of therapy prescribed influences persistence. Prescribing fixed combinations might be a good choice as initial therapy.Keywords: drug-utilization, adherence, fixed combination, hypertension |
