L Degli Esposti

Pharmacoutilization of antihypertensive drugs: a model of analysis.

OBJECTIVES To identify clinical and economic indicators of pharmacoutilization of antihypertensive drugs. PATIENTS AND METHODS 4614 subjects receiving a first prescription for amlodipine, atenolol, fosinopril, indapamide, or losartan were included in the study. All prescriptions filled during the study period from January 1, 1997 to December 31, 1998 were considered. A retrospective analysis was carried out on information recorded in the drug database. The percentage of patients continuing, discontinuing, and switching the initial treatment, duration of treatment, and doses used were calculated together with total costs. RESULTS A large proportion of patients (65.1%) discontinued the treatment. From the analysis of the mean daily dose taken by patients who continued the treatment, it was found that many subjects took a drug dosage which was below the therapeutic dose range, whereas the administration of doses above the therapeutic range occurred only occasionally. Continuation of treatment accounted for 48.1% of total costs, switching accounted for 20.8%, and discontinuation represented 31.1% of total expenditures. CONCLUSIONS With adequate markers, helpful data can be collected for monitoring the quality of antihypertensive drug prescriptions and the rational usage of resources in the general practice setting.

Adherence to antihypertensive drug treatment and blood pressure control: a real practice analysis in Italy.

Adherence to antihypertensive drug treatment and blood pressure control: a real practice analysis in Italy

The PANDORA project : results of the cost of illness analysis

Aims: To evaluate the cost of illness from hypertension for the Italian National Health System (NHS).Methods and Results: A prospective analysis was carried out on clinical and economic data recorded in the general practitioners’ (GPs) database. Twenty-one GPs working in the Ravenna area in Italy took part in the project on a voluntary basis. The study included 1047 hypertensive patients enrolled between 1 June and 31 December 1997 and continued for 365 days from the date of enrolment. The following costs were calculated: antihypertensive drugs, laboratory tests and instrumental procedures, GP visits for blood pressure control, specialist visits, casualty visits, hospitalisation due to cardiovascular problems. In the whole sample, the most relevant cost is due to antihypertensive drugs (42.7%), followed by hospital admission (28.4%), GP visits (15.1%) and tests (10.6%). The total mean cost was significantly lower in incident (no previous treatment) than in prevalent patients (already treated) (457 512 vs 725 573 Italian Lira (ITL), P < 0.05) and in older rather than in younger patients (1171 410 vs 796 452 (ITL) P < 0.05). (In the text the equivalent is given in Euros, Pounds Sterling and US dollars).Conclusion: Our study should be considered as preliminary, nevertheless it could represent a step towards the evaluation of the true cost of hypertension.

Use of antihypertensive and lipid-lowering drugs: the management of cardiovascular risk in clinical practice

The objective of the study was to analyse the treatment of high blood pressure (BP) and hypercholesterolaemia, as well as the effect of individual or combined antihypertensive-hypocholesterolaemic therapy on BP control and on circulating cholesterol. A retrospective study was performed using clinical data recorded in the general practitioners database. The sample included all patients, aged >/=18 years, with BP reading or low-density lipoprotein (LDL) cholesterol measurement recorded between January 2003 and December 2004. BP and LDL cholesterol targets were defined using cutoffs based on the guidelines of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) and the National Cholesterol Education Program (NCEP/ATPIII). The study included 4764 patients (mean age 67.6±11.8 years, 43.5% males). Target BP was achieved in a higher number of patients under combined antihypertensive-hypocholesterolaemic therapy than in those treated only with antihypertensives: 57.0 vs 50.0% in patients with history of cardio/cerebrovascular (CV) hospitalization, 27.0 vs 16.9% in patients with diabetes or chronic renal insufficiency (CRI) and 59.7 vs 49.1% in patients with no CV hospitalization nor diabetes and nor CRI. The LDL cholesterol target was achieved in 61.3% of the subjects: it was independent on the therapy (individual or combined), but related to the degree of cardiovascular risk. Analysing the data contained in the general medicine database made it possible to evaluate the treatment of high BP and hypercholesterolaemia in relation to cardiovascular risk in clinical practice and to establish the need to pay greater attention to achieving the objective set by guidelines.

The Nationwide Osmed Health-Db Database. A Tool To Support Healthcare Decision-Making And Real-World Evidence Generation.

A TOOL TO SUPPORT HEALTHCARE DECISION-MAKING AND REAL-WORLD EVIDENCE GENERATION Degli Esposti L1, Saragoni S1, Sangiorgi D1, Crovato E1, Blini V1, Buda S1, Paoli D1, Veronesi C1, Degli Esposti E1, Cangini A2, Russo P2 on the behalf of the OsMed Health-DB. 1CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy; 2 Italian Medicines Agency (AIFA-Agenzia Italiana del Farmaco), Roma, Italy. PRM61

Una prima valutazione economica dell’impiego di rofecoxib versus FANS convenzionali nell’artrosi

SummaryObjectiveRandomised clinical trials have demonstrated that rofecoxib has a better gastrointestinal tolerability profile than conventional nonsteroidal anti-inflammatory drugs (NSAIDs) in osteoarthritis, which results in a reduced utilisation of gastroprotective agents (GPA). The aim of this study was to estimate, from the national healthcare system perspective, the total drug costs in patients switched from NSAIDs plus GPAs to rofecoxib.DesignIn this longitudinal, observational study, drug prescriptions for symptomatic treatment of osteoarthritis were recorded. A decision tree was used to compare the mean daily drug cost of the following therapeutic options for ostheoarthritis: conventional NSAIDs and rofecoxib/conventional NSAIDs.SettingAzienda Unità Sanitaria Locale 110, Ravenna, Italy.Patients56,827 patients affected by osteoarthritis were monitored from January 1997 to December 1999. Of this group, we considered the first 2,935 patients who were examined by 21 General Practitioners in the period July 2000-October 2000, in order to point out changes in GPAs co-prescription after the introduction of rofecoxib in the Italian market.InterventionsAlternative treatments compared were: NSAIDs either alone or combined with GPAs (NSAIDs option), and just after the introduction of rofecoxib, NSAIDs or rofecoxib alone and NSAIDs or rofecoxib combined with GPAs (rofecoxib/NSAIDs option).Main outcome measures and results27,511 out of 56,827 patients (48.4%; IC 95%: 48.0–48.8%) treated with NSAIDs also received a GPA co-medication. In the aforementioned subgroup of 2,935 patients, 1,814 (62%) received multiple prescriptions of NSAIDs or rofecoxib. In this subgroup, rofecoxib was associated with a statistically significant reduction of GPAs utilisation of 58.8% (IC 95%: 30.7–80.1; p = 0.012) compared with what was recorded during treatment with NSAIDs. In fact, the mean daily cost per patient of the NSAIDs option was € 1.66 versus € 1.55 of the rofecoxib/NSAIDs option (6.6% lower).ConclusionsOur preliminary results suggest that the use of rofecoxib is associated with cost savings in terms of total drug costs compared with conventional NSAIDs.

PCV83 ADHERENCE WITH ANTIHYPERTENSIVE DRUG TREATMENT: EVIDENCE FROM PRIMARY CARE PRACTICE IN ITALY

(13.2%) were the most prescribed initial drugs. A total of 503,023 patients were considered for the adherence analysis: 34.9% of subjects had MPR < 0.4; 34.7% between 0.4 and 0.8; and 30.4% > 0.8. CONCLUSION: Persistent and adherence with hypolipemic medications is far from optimal in this large cohort of subjects. This phenomenon is common to many asymptomatic chronic therapies and deserves further investigations, as it indicates that a relevant part of drug resources are spent without a predictable clinical benefit.