Gainesville, FL—Prescribing a combination pill for high blood pressure might seem more expensive initially, but is actually much more cost-effective with regard to long-term health costs, a new study has shown.
Background information in the article, published recently in the Journal of Managed Care Pharmacy, points out that medication adjustment is necessary in the first year for about half of hypertension patients, because of either side effects or failure to reach blood pressure targets.
Switching to a fixed-dose combination leads to fewer follow-up physician visits and hospitalizations, according to the University of Florida (UF) study.
“It’s a win-win situation for everyone,” explained lead author Kalyani Sonawane, PhD, a clinical assistant professor of health services research, management, and policy at the UF College of Public Health and Health Professions. “From the patient and physician perspective, you achieve higher efficacy with fixed-dose combination and patients continue on the drug for a longer period of time and have better adherence. From the standpoint of managed-care organizations, you have greater economic savings from lower health services costs.”
The study found that patients on fixed-dose combination therapy are more likely to continue to take their pills and to take them as directed by their physician. It cites previous research finding that the fixed-dose combination is nearly five times more effective at controlling high blood pressure than other drug therapies.
In the current study led by Sonawane, who also is a pharmacist, researchers examined costs associated with the different drug-modification strategies.
Using the BlueCross BlueShield of Texas commercial claims database for the period from 2008 to 2012, the study team tracked the insurer’s annual drug costs and outpatient and inpatient disease-related health services costs for about 6,000 patients who had their blood pressure medications adjusted.
The most expensive drug therapy was a fixed-dose combination, which cost the health insurance plan an average of $310 a year, compared with $135 for switching to a new monotherapy, $63 for gradually increasing the dose of the current medication, and $61 for gradually decreasing the current drug.
On the other hand, the researchers assert, follow-up healthcare costs were lowest for patients on fixed-dose combinations. Inpatient costs for health services related to blood pressure or cardiovascular issues averaged $1,731 for patients on fixed-dose combinations, compared with $2,985 for patients taking decreasing doses of their medication; $7,076 for patients who switched to a new blood pressure drug and $7,692 for patients taking increasing doses.
Sonawane points out that physicians often are reluctant to prescribe fixed-dose combinations, partly because of the higher costs, but said she hopes the study will increase use of that option.
“Even though the drug costs for fixed-dose combination appear to be extremely high, it is offset by savings in health services costs, saving almost seven times the cost in inpatient visits,” Sonawane said.
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