Improving Adherence to Treatment and Reducing Economic Costs of Hypertension: The Role of Olmesartan-Based Treatment

Abstract

Poor adherence to antihypertensive treatment is the single most important factor of unsatisfactory blood pressure (BP) control. This review focuses on therapy-related factors affecting adherence and suggests how to improve it with a wise choice of treatment schedule. Complex drug treatment schemes, poor tolerability and drug substitutions are frequent causes of poor adherence which, in turn, causes insufficient BP control, greater incidence of cardiovascular events and, finally, higher global health costs. The effects of prescribing generic drugs and of drug substitutions on adherence is also discussed. In terms of adherence, generic drugs do not seem to be better than branded drugs, unless patients have to bear very high "out of pocket" expenses to buy original drugs, suggesting no advantages in switching drug with the mere goal of reducing the cost of therapy. An important role in improving adherence (and thus cardiovascular events and health expenditure) is also played by the availability of fixed-dose combinations; among antihypertensive drugs, angiotensin receptor blockers (ARBs) are those associated with higher levels of adherence and persistence. Among ARBs, olmesartan stands out for a wide choice of effective fixed-dose combinations.

Fixed dose drug combinations – are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries

“…A study in Canada also showed yearly medicine cost savings with FDCs [169], and a study in Japan also showed significant medicine cost savings with FDCs versus patients taking multiple tablets [170]. Other published studies involving high-income countries have also shown significantly lower costs for FDCs in CVD versus multiple tablets [45,[171][172][173][174]. However, Deshmukh et al (2017) in the US found the acquisition costs for FDCs were higher among patients being treated for their hypertension versus free-pill combinations although the higher costs were more than offset by lower inpatient costs [43].…”

Is early and fast blood pressure control important in hypertension management?

“…The use of fixed-dose combination therapies represents a very attractive strategy for improving BP control and represents today one of the key elements for a successful large-scale hypertension program with the aim of obtaining BP control in the large majority of hypertensive patients, as well as higher levels of adherence and persistence of the treatment [53]. In this view, a platform approach has been proposed to help physicians in making the most appropriate choice, with therapies founded on single-pill fixed dose combination of two or three drugs, on the basis of grade of hypertension, concomitant risk factors and organ damage and comorbidities [54,55].…”

Relación entre el control de la presión arterial y la adherencia al tratamiento medida mediante el sistema de receta XXI en Granada (España)

“…La adherencia al tratamiento ha sido identificada como uno de los factores más importantes para conseguir valores de presión arterial (PA) adecuados en pacientes hipertensos (1) . La adherencia sub-óptima (3) (el paciente sigue una pauta o dosis inferior a la recomendada por el médico), está asociada a una mayor incidencia de eventos cardiovasculares y, finalmente, mayores costos al sistema de salud (4)(5)(6) .…”