Abstract P55: Comparison of Real World Adherence, Healthcare Resource Utilization, and Cost for Valsartan/Amlodipine Single Pill Combination versus Angiotensin-Receptor Blocker/Calcium-Channel Blocker Free Combination Therapy

Abstract

Objective: To evaluate adherence, healthcare resource utilization and cost outcomes of valsartan/amlodipine single pill combination (SPC) versus angiotensin-receptor blocker (ARB)/calcium-channel blocker (CCB) free combination (FC) therapy in hypertensive patients. Methods: A retrospective database study was conducted using a large US commercial insurance claims database for the period 01/01/2007-04/30/2008. Two cohorts of patients receiving valsartan/amlodipine SPC or ARB/CCB FC were identified. All patients were ≥18 years old with at least 1 medical claim for hypertension (ICD 9 401.x-404.x) with ≥6 months pre- and ≥12 months post-index follow up and ≥2 filled prescriptions with days supply ≥90 days for the index therapy over follow up. Primary outcomes were proportion of days covered, days to discontinuation (defined as a gap in therapy of 30 days), and all-cause healthcare cost and utilization. Multivariate regression analysis was conducted to control for baseline characteristics, including age, gender, region, comorbidities, pill burden, and resource utilization and cost. Results: A total of 3259 (13.1%) of patients were included in the valsartan/amlodipine SPC cohort and 21,597 (86.9%) in the ARB/CCB FC cohort. At baseline, patients taking SPC were more likely to be male, older, and reside in the Southern US. After adjusting for baseline differences through risk-adjusted logistic regression, adherence rates for patients taking SPC therapy were significantly higher compared to patients taking FC therapy (OR 1.38, 95% CI 1.27-1.51). Patients taking SPC therapy were also significantly less likely to discontinue their index therapy (HR 0.87, p<0.001). Total all-cause health care costs were 11% greater for patients in the FC cohort compared to patients taking SPC therapy (p<0.001). In addition, patients in the SPC cohort were less likely to have ER visits and hospitalizations during the follow up period. Conclusion: Use of valsartan/amlodipine single pill combination therapy in hypertensive patients was associated with significantly better adherence and lower cost and healthcare resource utilization compared to ARB/CCB free combination therapy.