Real-life treatment patterns, compliance, persistence, and medication costs in patients with hypertension in Germany

Breitscheidel, Lusine; Ehlken, B; Kostev, Karel; Oberdiek, M. S. A.; Sandberg, Anna; Schmieder, Roland E.

doi:10.3111/13696998.2011.635229

Cited by 21 publications

(18 citation statements)

References 44 publications

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“…The total cost of CV events attributable to hypertension was estimated to exceed €51.3 [18] 81,843,743 [19] 46,815,916 [20] 65,281,000 [21] 52,642,500 [22] Percentage of females 51.48 % [18] 50.87 % [19] 50.65 % [20] 51.57 % [21] 50.84 % [22] Percentage of females; age C 30 years 71.76 % [18] 70.86 % [19] 69.37 % [20] 64.76 % [21] 63.54 % [22] Percentage of males; age C 30 years 68.59 % [18] 68.33 % [19] 67.05 % [20] 61.39 % [21] 61. 17 Percentage of diagnosed and treated hypertensive subjects 73.00 % [30] 77.00 % [31] 59.40 % [26] 56.92 % [27,29] 58.38 % [32] Percentage of diagnosed patients with adherence C80 % 41.50 % [9] 66.90 % [13] 39.40 % [14] 39.00 % [12] 56.85 % [11] billion over a time span of 10 years (range €5.0 in England and €17.1 in Germany). Considering only the costs associated with diagnosed and treated patients, drug cost is estimated, on average, to represent 37 % (range 10 % in England and 71 % in Spain) of the total cost of the disease and the remaining part being attributed to hospitalisations (Table 5).…”

Section: Scenarios and Sensitivity Analysesmentioning

confidence: 99%

“…A level of good adherence needed for a pharmacological treatment to be effective is widely recognized to be around 80 % of the prescribed therapy [9]. Existing research shows that in several European countries \60 % of treated hypertensive subjects have an adherence to their treatment over 80 % [10][11][12][13][14]. Poor adherence results in severe losses in terms of clinical efficacy and economic efficiency, especially as the cardiovascular events that full adherence could avoid translate into greater hospitalisation costs.…”

Section: Introductionmentioning

confidence: 99%

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Cost of poor adherence to anti-hypertensive therapy in five European countries

et al. 2014

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The financial burden for EU health systems associated with cardiovascular disease (CV) has been estimated to be nearly €110 billion in 2006, corresponding to 10 % of total healthcare expenditure across EU or a mean €223 annual cost per capita. The main purpose of this study is to estimate the costs related to hypertension and the economic impact of increasing adherence to anti-hypertensive therapy in five European countries (Italy, Germany, France, Spain and England). A probabilistic prevalence-based decision tree model was developed to estimate the direct costs of CV related to hypertension (CV defined as: stroke, heart attack, heart failure) in five European countries. Our model considered adherence to hypertension treatment as a main driver of blood pressure (BP) control (BP \ 140/ 90 mmHg). Relative risk of CV, based on controlled or uncontrolled BP group, was estimated from the Framingham Heart Study and national review data. Prevalence and cost data were estimated from national literature reviews. A national payer (NP) perspective for 10 years was considered. Probabilistic sensitivity analysis was performed in order to evaluate uncertainty around the results (given as 95 % confidence intervals). The model estimated a total of 8.6 million (1.4 in Italy, 3.3 in Germany, 1.2 in Spain, 1.8 in France and 0.9 in England) CV events related to hypertension over the 10-year time horizon. Increasing the adherence rate to antihypertensive therapy to 70 % (baseline value is different for each country) would lead to 82,235 fewer CV events (24,058 in Italy,7,870 in Germany,18,870 in Spain,24,855 in France and 6,553 in England). From the NP perspective, the direct cost associated with hypertension was estimated to be €51.3Electronic supplementary material The online version of this article (doi:10.1007/s10198-013-0554-4) contains supplementary material, which is available to authorized users. 123Eur J Health Econ (2015) 16:65-72 DOI 10.1007 billion (8.1 in Italy, 17.1 in Germany, 12.2 in Spain, 8.8 in France and 5.0 in England). Increasing adherence to antihypertensive therapy to 70 % would save a total of €332 million (CI 95 %: €319-346 million) from the NPs perspective. This study is the first attempt to estimate the economic impact of non-adherence amongst patients with diagnosed hypertension in Europe, using data from five European countries (Italy, France, Germany, Spain and England).

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Section: Scenarios and Sensitivity Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost of poor adherence to anti-hypertensive therapy in five European countries

et al. 2014

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“…And while FDCs may improve adherence to both medicines, an individual initiating on a free combination has more freedom to switch to other medicines and doses and to discontinue only one of the two medicines if necessary. Further, there is a risk of publication bias, as nearly all studies were conducted or funded by pharmaceutical companies; [15][16][17]23,[43][44][45][46][47][48][49][50][51][52] research has shown that industry-sponsored studies tend to produce favourable results. 53 This study is one of the few studies of adherence to FDCs conducted arm's length to industry.…”

Section: Discussionmentioning

confidence: 99%

Who benefits from fixed‐dose combinations? Two‐year statin adherence trajectories in initiators of combined amlodipine/atorvastatin therapy

Schaffer

Buckley

Pearson

2017

Pharmacoepidemiology and Drug

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“…SPC may also decrease the costs for BP management as shown in Swiss and German primary care. 12 , 13 …”

Section: Discussionmentioning

confidence: 99%

“… 9 – 11 In clinical trials and cohort studies, SPC of antihypertensive agents are associated with a significant improvement in compliance and with nonsignificant beneficial trends in BP and adverse effects as compared with the same substances given as individual pills. 11 In general practice, SPC seem to be broadly used nowadays, 12 – 14 and some reports describe a higher likelihood of successful BP control when substances are given as SPC instead of FIC. 15 This suggests that the superior efficacy of SPC documented in controlled clinical trials 16 may translate into improved BP control in daily practice.…”

Section: Introductionmentioning

confidence: 99%

Antihypertensive combination therapy in primary care offices: results of a cross-sectional survey in Switzerland

Roas

Bernhart²,

Schwarz³

et al. 2014

IJGM

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BackgroundMost hypertensive patients need more than one substance to reach their target blood pressure (BP). Several clinical studies indicate the high efficacy of antihypertensive combinations, and recent guidelines recommend them in some situations even as initial therapies. In general practice they seem widespread, but only limited data are available on their effectiveness under the conditions of everyday life. The objectives of this survey among Swiss primary care physicians treating hypertensive patients were: to know the frequency of application of different treatment modalities (monotherapies, free individual combinations, single-pill combinations); to see whether there are relationships between prescribed treatment modalities and patient characteristics, especially age, treatment duration, and comorbidities; and to determine the response rate (percentage of patients reaching target BP) of different treatment modalities under the conditions of daily practice.MethodsThis cross-sectional, observational survey among 228 randomly chosen Swiss primary care physicians analyzed data for 3,888 consecutive hypertensive patients collected at one single consultation.ResultsIn this survey, 31.9% of patients received monotherapy, 41.2% two substances, 20.9% three substances, and 4.7% more than three substances. By combination mode, 34.9% took free individual combinations and 30.0% took fixed-dose single-pill combinations. Combinations were more frequently given to older patients with a long history of hypertension and/or comorbidities. In total, 67.8% of patients achieved their BP target according to their physician’s judgment. When compared, single-pill combinations were associated with a higher percentage of patients achieving target BP than free individual combinations and monotherapies for the total sample and for patients with comorbidity.ConclusionAntihypertensive combination therapy was widely used in Swiss primary care practices. The number of prescribed substances depended on age, treatment duration, and type and number of comorbidities. Although the response rate was generally modest under the conditions of daily practice, it was higher for single-pill combinations than for monotherapies and free individual combinations. Further studies are needed to confirm these observations.

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Real-life treatment patterns, compliance, persistence, and medication costs in patients with hypertension in Germany

Cited by 21 publications

References 44 publications

Cost of poor adherence to anti-hypertensive therapy in five European countries

Cost of poor adherence to anti-hypertensive therapy in five European countries

Who benefits from fixed‐dose combinations? Two‐year statin adherence trajectories in initiators of combined amlodipine/atorvastatin therapy

Antihypertensive combination therapy in primary care offices: results of a cross-sectional survey in Switzerland

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