Abstract
OBJECTIVES:Single-pill combination therapy (amlodipine/atorvastatin) might be more effective than double-pill therapy (amlodipine+atorvastatin) in patients with diabetes and concomitant hypertension requiring statin therapy. We compared the cost-effectiveness of a single-pill with that of double-pill for control of low density lipoprotein cholesterol (LDL-C) levels, with the ultimate goal of cardiovascular disease prevention, in these patients using a cost-effectiveness analysis model that considered medication adherence.METHODS:Effectiveness was defined as the percentage (%) attainment of target LDL-C levels (<100 mg/dL) based on adherence for each therapy. Adherence was defined as compliance to medication (≥80% proportion of days covered). A systematic review of the literature was conducted to determine the proportion of patients who were adherent and target goal attainment based on adherence level. The annual medication costs were based on the adherence levels for each regimen. The average cost-effectiveness ratio (ACER) was calculated as the cost per % attainment of the target LDL-C level.RESULTS:The ACER for the single-pill regimen was lower than for the double-pill regimen (4,123 vs. 6,062 Korean won per 1% achievement of target goal). Compared with the double-pill, the medication costs were approximately 32% lower with the single-pill.CONCLUSION:A single-pill for reductions in LDL-C is cost-effective compared with double-pill in hypertensive patients with type 2 diabetes.
Highlights
The analysis model of this study evaluated the cost-effectiveness of the use of amlodipine and atorvastatin in patients with diabetes who were on blood pressure-lowering medication to reach the target LDL-C level
KRW, Korean won; ATR, atorvastatin; AML, amlodipine. 1Adherent≥ 80% proportion of days covered: 2013 weighted average price used for unit price
Medication adherence rates are expressed as proportion of days covered (PDC) or medication possession ratio (MPR); both are calculated using the number of medications prescribed during the prescription period
Summary
According to literature published in 2011, the prevalence of cardiovascular diseases (CVDs) is sharply increasing, as are the Received: Nov 13, 2014, Accepted: Feb 22, 2015, Published: Feb 22, 2015 This article is available from: http://e-epih.org/. This trend is reportedly related to the increasing rates of hypertension, diabetes, dyslipidemia, and obesity [1]. When these diseases are concomitant, the risk of CVDs increases. For patients with diabetes, the additional burden of hypertension and dyslipidemia significantly increases the risk of CVDs. recent treatment guidelines recommend strict control of blood cholesterol levels (low density lipoprotein cholesterol [LDL-C] < 100 mg/dL) in addition to effective blood pressure management to prevent CVDs [3,4]
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