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1.
Presse Med ; 48(12): 1520-1526, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31761608

RESUMO

Non-adherence to antihypertensive treatment is one of the critical contributors to sub-optimal blood pressure control. The French Society of Hypertension remembered that urine and serum biochemical detection of antihypertensive drugs could be useful in a patient with resistant hypertension. Talking to a patient with biochemically confirmed non-adherence to blood pressure-lowering therapy and repeating them improved adherence to drugs. Despite its usefulness, biochemical detection of antihypertensive drugs is not routinely effective in France as they are not reimbursed by French Medical Care, except in patients attending hospitals. The list of blood pressure-lowering drugs able to be biochemically detected in France and their modalities are recorded here.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Adesão à Medicação/estatística & dados numéricos , Anti-Hipertensivos/economia , Pressão Sanguínea/efeitos dos fármacos , Formas de Dosagem , Custos de Medicamentos , França/epidemiologia , Humanos , Hipertensão/economia
3.
BMC Health Serv Res ; 19(1): 373, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196079

RESUMO

BACKGROUND: Hypertension remains one of the leading causes of death in Nigeria. Appropriate and cost-effective treatment of the disease is necessary to reduce mortality. This study evaluates (i) the prescription patterns and quality (ii) blood pressure control and (iii) cost of medication among patients with hypertension uncomplicated by co-morbid diseases or compelling indications. METHOD: Patients with uncomplicated hypertension attending three clinics in the University College Hospital, Ibadan in Nigeria were recruited into this study. Information on demographics, antihypertensive medication prescribed, blood pressure measurements, and cost of medications were collected for each patient. Antihypertensive medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) system. The frequency of usage of each drug class and their prescribed doses per patient/day were calculated and compared with the DDD to assess the quality of prescription. Cost of antihypertensive medication was calculated for each patient and reported as cost per patient/day and cost per patient/month. Effect of variables on BP control was ascertained. Statistical analyses were done using SPSS, chi-square and correlation test was used to test for associations. RESULT: A total number of 1050 hypertensive patients were included in this study. The mean age was 60 years, females made up 62% of the study population. A high level of polypharmacy (87%) and sub-optimal blood pressure control was observed. An increase in blood pressure was observed with increase in the number of medication prescribed (χ2 = 33.618, p < 0.001; r = .18, p < 0.001). The most prescribed antihypertensive medication either as a single therapy or a fixed-dose combination was diuretic. About 54% of the prescribed daily doses of antihypertensive medication exceeded the DDD. The total monthly expenditure on antihypertensive drugs was approximately N3.2 million ($15,300). CONCLUSION: Study findings show a high level of polypharmacy and non-generic prescribing. Increased prescribing of drugs that are cost-effective, as well as prescription of fixed dose combinations (FDCs), is recommended in hypertensive patients. This is necessary to control blood pressure while increasing treatment adherence.


Assuntos
Anti-Hipertensivos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Hipertensão/tratamento farmacológico , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/economia , Análise Custo-Benefício , Prescrições de Medicamentos/economia , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/economia , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia
4.
PLoS One ; 14(6): e0217798, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31170217

RESUMO

Phosphodiesterase-5 inhibitors (PDE-5I) have demonstrated improvement in disease symptoms and quality of life for patients with pulmonary arterial hypertension (PAH). Despite these benefits, reported adherence to PDE-5I therapy is sub-optimal. Clinical pharmacists at an integrated practice site are in a unique position to mitigate barriers related to PAH therapy including medication adherence and costs. The primary objective of this study was to assess medication adherence to PDE-5I therapy within an integrated care model at an academic institution. The secondary objective was to assess the impact of out-of-pocket (OOP) cost, frequency of dosing, adverse events (AE) and PAH-related hospitalizations on medication adherence. We performed a retrospective cohort analysis of adult patients with PAH who were prescribed PDE-5I therapy by the center's outpatient pulmonary clinic and who received medication management through the center's specialty pharmacy. We defined optimal medication adherence as proportion of days covered (PDC) ≥ 80%. Clinical data including AEs and PAH-related hospitalizations were extracted from the electronic medical record, and financial data from pharmacy claims. Of the 131 patients meeting inclusion criteria, 94% achieved optimal adherence of ≥ 80% PDC. In this study population, 47% of patients experienced an AE and 27% had at least one hospitalization. The median monthly OOP cost was $0.62. Patients with PDC<80% were more likely to report an AE compared to patients with PDC≥ 80% (p = 0.002). Hospitalization, OOP cost, and frequency of dosing were not associated with adherence in this cohort. Patients receiving PDE-5I therapy through an integrated model achieved high adherence rates and low OOP costs.


Assuntos
Adesão à Medicação/estatística & dados numéricos , Farmácia , /tratamento farmacológico , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , /economia
6.
J Manag Care Spec Pharm ; 25(6): 678-686, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31134857

RESUMO

BACKGROUND: Approximately 32% (75 million) of adults have hypertension in the United States, leading to 1,100 daily deaths and costing more than $48 billion annually in medical expenditures. Approximately 25% of patients with hypertension require triple combination therapy to reach recommended blood pressure. Currently, only 3 single-pill triple-combination therapies are available in the market for the treatment of hypertension. Medication adherence has become a major concern for the health care system, and nonadherence is associated with higher risks of morbidity and mortality. OBJECTIVE: To compare medication adherence rates among single-pill triple-combination therapy, free triple-combination therapy, and fixed-dose dual-combination therapy plus a third agent in hypertensive patients enrolled in a Medicare Advantage prescription drug plan using 2 adherence definitions. METHODS: A retrospective cohort study was conducted using Cigna-HealthSpring's medical claims database from January 2014 to December 2016. Antihypertensive combination therapy users were classified into a single-pill triple-combination group, a fixed-dose dual-combination plus a third agent group, and a free triple-combination group. Adherence rates using proportion of days covered (PDC) were calculated for each group within a 1-year follow-up period using 2 definitions: a strict one requiring all antihypertensive agents during follow-up and a more relaxed definition requiring any antihypertensive agent during follow-up. Descriptive statistics were examined, and group differences were assessed using chi-square and analysis of variance. Multivariate logistic regression was conducted to control confounders of adherence using both definitions. RESULTS: 10,836 triple-combination users were identified. In the multivariate model using the first definition, fixed-dose dual-combination plus a third agent was significantly associated with lower adherence compared with single-pill triple therapy (OR = 0.177; 95% CI = 0.119-0.263; P < 0.001). No significant difference was detected between single-pill triple-combination therapy in comparison with free-combination therapy. In the multivariate model using the second definition, fixed-dose dual-combination plus a third agent and free-combination therapy were significantly associated with better adherence in comparison with single-pill triple combination therapy (OR = 3.62, 95% CI = 2.59-5.05; OR = 4.31, 95% CI = 2.15-8.64, respectively). Younger age, female gender, language (Spanish), some comorbidities, and previous hospitalization had a negative effect on adherence. CONCLUSIONS: Measuring adherence to multiple concurrent regimens is complicated and different adherence definitions can result in significant variations in adherence measures. Future research evaluating clinical outcomes with various definitions is needed. DISCLOSURES: No outside funding supported this study. Abughosh reports grants from Sanofi, Regeneron, Valeant Pharmaceuticals, BMS/Pfizer, and PhRMA, not related to this study. Serna reports employement with CareAllies, a Cigna company. The other authors have no conflicts of interest to disclose.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/economia , Anti-Hipertensivos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Combinação de Medicamentos , Quimioterapia Combinada/economia , Quimioterapia Combinada/métodos , Quimioterapia Combinada/estatística & dados numéricos , Feminino , Humanos , Hipertensão/economia , Masculino , Medicare Part C/economia , Medicare Part C/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Estados Unidos
7.
Ther Adv Respir Dis ; 13: 1753466619843774, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30983530

RESUMO

INTRODUCTION: Since its introduction to the market in 2016, selexipag has been an alternative oral therapy among both treatment-naïve patients and those with mono or dual therapy failure; however, limited information is available regarding the presentation and management of patients with pulmonary arterial hypertension (PAH) prior to selexipag initiation. This study examined treatment patterns, healthcare utilization, and costs in the 12 months prior to and the 6 months following selexipag initiation. METHODS: This was a retrospective study of adult commercial and Medicare Advantage with Part D (MAPD) health plan members with a medical or pharmacy claim for selexipag from 1 January 2016 through 31 May 2017, a diagnosis of pulmonary hypertension, and continuous health plan enrollment for 12 months prior to selexipag initiation (baseline period). Treatment patterns, healthcare utilization, and costs were measured over the baseline period and the 6 months following selexipag initiation (among patients with ⩾6 months of follow up). RESULTS: After inclusion and exclusion criteria were applied, 95 patients were included in the analysis. At study start, 57.9% of patients were prescribed combination therapy, increasing to 69.5% immediately prior to selexipag initiation. Approximately 60% of patients had one baseline regimen. Emergency visits and inpatient admissions during the baseline period occurred in 63.2% and 48.4% of patients, respectively. Baseline medical costs rose steadily, increasing 266.8% in commercial and 26.7% in MAPD enrollees from the beginning to the end of the 12-month baseline period. PAH-related healthcare costs accounted for more than 80% of total costs. Mean medical costs in the 6 months following selexipag initiation were US$17,215 in commercial and US$23,976 in MAPD enrollees. CONCLUSIONS: The majority of patients with PAH remained on the same therapy in the 12 months prior to selexipag initiation despite high rates of healthcare utilization and increasing costs. Mean medical costs appeared to decrease after adding or switching to selexipag.


Assuntos
Acetamidas/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Custos de Cuidados de Saúde/estatística & dados numéricos , Hipertensão Pulmonar/tratamento farmacológico , Pirazinas/uso terapêutico , Acetamidas/economia , Idoso , Anti-Hipertensivos/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão Pulmonar/economia , Masculino , Medicare Part C , Medicare Part D , Pessoa de Meia-Idade , Pirazinas/economia , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos
8.
Mar Drugs ; 17(3)2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30818811

RESUMO

The objective of this report was to investigate the isolation and recovery of different biocompounds and bioproducts from wastes (skins and heads) that were obtained from five species discarded by fishing fleets (megrim, hake, boarfish, grenadier, and Atlantic horse mackerel). Based on chemical treatments, enzymatic hydrolysis, and bacterial fermentation, we have isolated and produced gelatinous solutions, oils that are rich in omega-3, fish protein hydrolysates (FPHs) with antioxidant and antihypertensive activities, and peptones. FPHs showed degrees of hydrolysis higher than 13%, with soluble protein concentrations greater than 27 g/L and in vitro digestibilities superior to 90%. Additionally, amino acids compositions were always valuable and bioactivities were, in some cases, remarkable. Peptones that were obtained from FPHs of skin and the heads were demonstrated to be a viable alternative to expensive commercial ones indicated for the production of biomass, lactic acid, and pediocin SA-1 from Pediococcus acidilactici.


Assuntos
Produtos Biológicos/isolamento & purificação , Ácidos Graxos Ômega-3/isolamento & purificação , Peixes , Peptonas/isolamento & purificação , Hidrolisados de Proteína/isolamento & purificação , Animais , Anti-Hipertensivos/economia , Anti-Hipertensivos/isolamento & purificação , Anti-Hipertensivos/farmacologia , Antioxidantes/economia , Antioxidantes/isolamento & purificação , Antioxidantes/farmacologia , Bactérias/metabolismo , Produtos Biológicos/economia , Produtos Biológicos/farmacologia , Ácidos Graxos Ômega-3/economia , Ácidos Graxos Ômega-3/farmacologia , Fermentação , Pesqueiros/economia , Cabeça , Hidrólise , Peptonas/economia , Peptonas/farmacologia , Hidrolisados de Proteína/economia , Hidrolisados de Proteína/farmacologia , Pele/química , Espanha
9.
PLoS One ; 14(2): e0212832, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817790

RESUMO

INTRODUCTION: Renin-angiotensin system inhibitors (RAS) drugs have a proteinuria-reducing effect that could prevent the progression of kidney disease in diabetic patients. Our study aimed to assess the budget impact based on healthcare payer perspective of increasing uptake of RAS drugs into the current treatment mix of standard anti-hypertensive treatments to prevent progression of kidney disease in patient's comorbid with hypertension and diabetes. METHODS: A Markov model of a Malaysian hypothetical cohort aged ≥30 years (N = 14,589,900) was used to estimate the total and per-member-per-month (PMPM) costs of RAS uptake. This involved an incidence and prevalence rate of 9.0% and 10.53% of patients with diabetes and hypertension respectively. Transition probabilities of health stages and costs were adapted from published data. RESULTS: An increasing uptake of RAS drugs would incur a projected total treatment cost ranged from MYR 4.89 billion (PMPM of MYR 27.95) at Year 1 to MYR 16.26 billion (PMPM of MYR 92.89) at Year 5. This would represent a range of incremental costs between PMPM of MYR 0.20 at Year 1 and PMPM of MYR 1.62 at Year 5. Over the same period, the care costs showed a downward trend but drug acquisition costs were increasing. Sensitivity analyses showed the model was minimally affected by the changes in the input parameters. CONCLUSION: Mild impact to the overall healthcare budget has been reported with an increased utilization of RAS. The long-term positive health consequences of RAS treatment would reduce the cost of care in preventing deterioration of kidney function, thus offsetting the rising costs of purchasing RAS drugs. Optimizing and increasing use of RAS drugs would be considered an affordable and rational strategy to reduce the overall healthcare costs in Malaysia.


Assuntos
Antagonistas de Receptores de Angiotensina/economia , Inibidores da Enzima Conversora de Angiotensina/economia , Anti-Hipertensivos/economia , Análise Custo-Benefício , Custos de Cuidados de Saúde , Adulto , Antagonistas de Receptores de Angiotensina/farmacologia , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Orçamentos , Estudos de Coortes , Comorbidade , Redução de Custos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/economia , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/prevenção & controle , Progressão da Doença , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/economia , Hipertensão/epidemiologia , Incidência , Malásia/epidemiologia , Modelos Econômicos , Prevalência , Sistema Renina-Angiotensina/efeitos dos fármacos
10.
Prev Chronic Dis ; 16: E32, 2019 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-30900546

RESUMO

We used administrative claims data from 2014 on people with employer-sponsored health insurance to assess the proportion of patients taking antihypertensive medications, rates of nonadherence to these medication regimens, and out-of-pocket costs paid by patients. We performed multivariate logistic regression analysis to examine the association between out-of-pocket costs and nonadherence. Results indicated that patients filled the equivalent of 13 monthly prescriptions and paid $76 out of pocket over the calendar year; the likelihood of nonadherence increased as out-of-pocket costs increased (adjusted odds ratios ranged from 1.04 to 1.78; P < .001). These findings suggest a need for improvement in adherence among patients with employer-sponsored insurance.


Assuntos
Anti-Hipertensivos/economia , Gastos em Saúde/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Adulto , Anti-Hipertensivos/uso terapêutico , Análise Custo-Benefício , Feminino , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/economia , Hipertensão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estados Unidos/epidemiologia
11.
PLoS One ; 14(2): e0211759, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785916

RESUMO

Under the Universal Coverage Scheme (UCS) with payment per capita for outpatient (OP) services, hospitals' financial risks will rise if access to essential drugs increases. This study examined trends in access to and price of essential drugs for noncommunicable diseases (NCDs) and an overall purchasing price index (PPI) for an OP drug basket from public hospitals. To examine drug access, OP prescription data from 2010-2012 were obtained from the UCS. Access to thirteen drugs for diabetes, hypertension, and dyslipidemia was examined for trend using a time-series analysis. To calculate the PPI, drugs in the same dataset in 2010 that each contributed at least 0.2% of the total OP drug expenditure (N = 118 items) were selected together with drugs expected for near future growth (N = 48 items). The PPI was constructed from purchasing prices in 16 hospitals using a standard method developed by the International Labour Organization. Based on 166 drug items accounting for 75% of OP drug expenditures, the overall PPI continually declined by 6.8% from 2010 to 2012. Access to the 13 selected NCD drugs, accounting for 22% of the total OP drug expenditure increased from 22 to 30 per 1,000 population for antidiabetics, 27 to 47 for antihypertensive agents, and 32 to 53 for antilipidemics from 2010-2012. Growth in the study drug recipients was relatively higher than that in the population and diagnosed patients. Due to generic market competition, metformin, glipizide, amlodipine, losartan, simvastatin, atorvastatin, and fenofibrate prices decreased by 6-22%. Antiretrovirals and risperidone prices decreased by more than 10% due to price negotiation by the UCS. Access to essential drugs for diabetes, hypertension and dyslipidemia has increased. A decline in the PPI could contain essential drug expenditure when the demand for the drugs increased. Generic market competition and price negotiation by the UCS led to price reduction.


Assuntos
Anti-Hipertensivos/economia , Custos de Medicamentos , Gastos em Saúde , Hipoglicemiantes/economia , Hipolipemiantes/economia , Cobertura Universal do Seguro de Saúde/economia , Medicamentos Genéricos/economia , Humanos , Pacientes Ambulatoriais , Tailândia
12.
BMC Fam Pract ; 20(1): 10, 2019 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642264

RESUMO

BACKGROUND: Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socio-economic standard, and access to medical services and public pharmacies in urban, rural and island environments (city of Split vs. Dalmatian Hinterland vs. islands in Southern Croatia). METHODS: A historical cohort study included 213 patients diagnosed from 2008 to 2014 with essential arterial hypertension (AH) and without related complications or diabetes mellitus. Each patient was followed up for 365 days from the visit when the diagnosis of hypertension was ascertained. Normotension was defined as arterial pressure < 140/90 mmHg. The annual cost of drugs prescribed for treating newly diagnosed hypertensive patient and the total price for defined daily dose per patient were also evaluated. RESULTS: More than half patients achieved normotension within a year from the initial diagnosis in all family medicine practices (57.3%), without significant differences among the three geographic regions (P = 0.981). Higher initial systolic blood pressure was a positive predictive prognostic factor on achieveing normotension (odds ratio (OR) 0.96, 95% confidence interval 0.95-0.98). ACE inhibitors were the most commonly prescribed antihypertensive agents in monotherapy (35.1%), as well as considering overall prescriptions (25.2%). Calcium channel blockers were the most commonly prescribed initial BP-lowering single agents in urban areas (28.6%), whereas angiotensin-converting enzyme inhibitors were more common in rural (28.0%) and island areas (22.7%) (P = 0.037). The median annual antihypertensive drug cost was 169.4 (95% CI 151.5-201.8) Croatian kunas and was similar across the study sites. CONCLUSION: Multiple antihypertensive drugs, prescribed in accordance with the guidelines, lead to similar pharmacological effects. Primary care physicians seem to be able to overcome potential interfering socio-economic factors and successfully achieve normotension in newly diagnosed patients with uncomplicated AH after 1 year of treatment.


Assuntos
Anti-Hipertensivos/uso terapêutico , Medicina de Família e Comunidade , Hipertensão/tratamento farmacológico , Inibidores da Enzima Conversora de Angiotensina/economia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/economia , Bloqueadores dos Canais de Cálcio/economia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Croácia , Custos de Medicamentos , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , População Rural , Resultado do Tratamento , População Urbana
13.
Int J Clin Pharm ; 41(1): 81-87, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30478491

RESUMO

Background In the South African private sector context, generically similar products are grouped together and the reimbursement rate is set at the average price of the generically equivalent products. Very little evidence exists in low and middle-income countries with regards to the impact of this policy over time. Objectives To determine the impact of the introduction of generics and generic reference pricing on candesartan and rosuvastatin in the South African private health care sector in terms of medicine utilisation, medicine price and medicine expenditure. Setting South African private health sector. Method Medicine claims for candesartan and rosuvastatin was obtained from a Pharmacy Benefit Manager in South Africa. The claims covered a 48-month period from January 2012 to December 2015 and provided a pre- and post-reference price period for analysis. Medicine utilisation was measured as the number of Defined Daily Doses dispensed per 100,000 beneficiaries. Medicine price and expenditure was calculated as the average per Defined Daily Dose. Main outcome measure Medicine utilisation, price and expenditure. Results Candesartan experienced an average 7.0% year-on-year decline in utilisation and rosuvastatin a 5.0% increase. Medicine expenditure reduced by an additional 34.6% and 20.9% for candesartan and rosuvastatin respectively. The total savings was 54.8% for candesartan and 31.9% for rosuvastatin. Conclusion The introduction of generics and generic reference pricing did not have an impact on medicine utilisation, but reduced the price and expenditure of both candesartan and rosuvastatin.


Assuntos
Benzimidazóis/economia , Custos de Medicamentos , Uso de Medicamentos/economia , Medicamentos Genéricos/economia , Gastos em Saúde , Rosuvastatina Cálcica/economia , Tetrazóis/economia , Anticolesterolemiantes/economia , Anticolesterolemiantes/uso terapêutico , Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Benzimidazóis/uso terapêutico , Custos de Medicamentos/tendências , Uso de Medicamentos/tendências , Medicamentos Genéricos/uso terapêutico , Gastos em Saúde/tendências , Humanos , Rosuvastatina Cálcica/uso terapêutico , África do Sul/epidemiologia , Tetrazóis/uso terapêutico
14.
Hypertension ; 73(1): 142-147, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30571542

RESUMO

The new American College of Cardiology/American Heart Association 2017 Hypertension Guidelines lower the threshold to define hypertension, thus increasing its prevalence. The impact on populations and health systems is poorly understood. We included data from 990 subjects aged 20 to 64 years from the SALMEX cohort (Salt in Mexico; Mexico City) and determined the prevalence of hypertension and requirement for pharmacological treatment according to both Joint National Committee on the Prevention, Detection, and Treatment of High Blood Pressure 7 and American College of Cardiology/American Heart Association 2017 guidelines. The data obtained were extrapolated to sex- and age-adjusted Mexico City population, and annual costs of medical follow-up were calculated. The new definition increased the prevalence of hypertension among SALMEX cohort from 16.2% to 37.4% (18%-39.3% after adjusting to Mexico City population). The proportion of subjects that require pharmacological and nonpharmacological treatment increased from 17.7% to 19.0% and from 17.7% to 37.4%, respectively (19.4%-21.8% for pharmacological and 19.4%-39.3% for nonpharmacological treatment, after adjusting to Mexico City population). Annual costs of medical follow-up for subjects with hypertension in Mexico City would increase an estimated $59 278 928. The requirement to initiate pharmacological treatment was similar when assessed by Framingham risk score with lipids or with body mass index compared with the Atherosclerotic Cardiovascular Disease score, with correlation κ indexes of 0.981 and 0.972, respectively. On the basis of these results, Framingham body mass index represents an attractive and potentially cost-effective alternative to assess cardiovascular risk. In conclusion, the adoption of the new guidelines in Mexican population has implications not only on its prevalence but also on medical follow-up costs. A pharmacoeconomic model is required to assess the actual financial impact.


Assuntos
Anti-Hipertensivos , Cardiologia , Hipertensão , Guias de Prática Clínica como Assunto/normas , Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Cardiologia/métodos , Cardiologia/normas , Cardiologia/tendências , Estudos de Coortes , Custos e Análise de Custo , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/economia , Hipertensão/epidemiologia , México/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , Prevalência , Fatores de Risco
15.
Hypertension ; 73(1): 121-131, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30571548

RESUMO

Previous cost-effectiveness models found ambulatory blood pressure monitoring (ABPM) to be a favorable strategy to diagnose hypertension; however, they mostly focused on older adults with a positive clinic blood pressure (BP) screen. We evaluated the cost-effectiveness of 3 methods of BP measurement for hypertension diagnosis in primary care settings among 14 age- and sex-stratified hypothetical cohorts (adults ≥21 years of age), accounting for the possibility of both false-positive (white-coat hypertension) and false-negative (masked hypertension) clinic measurements. We compared quality-adjusted life-years and lifetime costs ($US 2017 from the US healthcare perspective) associated with clinic BP measurement, home BP monitoring, and ABPM under 2 scenarios: positive and negative initial screen. Model parameters were obtained from published literature, publicly available data sources, and expert input. In the screen-positive scenario, ABPM was the dominant strategy among all age and sex groups. Compared with clinic BP measurement, ABPM was associated with cost-savings ranging from $77 (women 80 years of age) to $5013 (women 21 years of age). In the screen-negative scenario, ABPM was the dominant strategy in all men and women <80 years of age with cost-savings ranging from $128 (women 70 years of age) to $2794 (women 21 years of age). Sensitivity analyses showed that results were sensitive to test specificity and antihypertensive medication costs. ABPM is recommended as the diagnostic strategy of choice for most adults in primary care settings regardless of initial screening results.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Custos de Cuidados de Saúde/estatística & dados numéricos , Hipertensão , Atenção Primária à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/economia , Determinação da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/economia , Monitorização Ambulatorial da Pressão Arterial/métodos , Análise Custo-Benefício , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/economia , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/métodos , Anos de Vida Ajustados por Qualidade de Vida , Sensibilidade e Especificidade , Estados Unidos/epidemiologia
16.
Can Respir J ; 2018: 1015239, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30581511

RESUMO

Objectives: Although many studies have reported on the cost-effectiveness of bosentan for treating pulmonary arterial hypertension (PAH), a systematic review of economic evaluations of bosentan is currently lacking. Objective evaluation of current pharmacoeconomic evidence can assist decision makers in determining the appropriate place in therapy of a new medication. Methods: Systematic literature searches were conducted in English-language databases (MEDLINE, EMBASE, EconLit databases, and the Cochrane Library) and Chinese-language databases (China National Knowledge Infrastructure, WanFang Data, and Chongqing VIP) to identify studies assessing the cost-effectiveness of bosentan for PAH treatments. Results: A total of 8 published studies were selected for inclusion. Among them were two studies comparing bosentan with epoprostenol and treprostinil. Both results indicated that bosentan was more cost-effective than epoprostenol, while the results of bosentan and treprostinil were not consistent. Four studies compared bosentan with other endothelin receptor antagonists, which indicated ambrisentan might be the drug of choice for its economic advantages and improved safety profile. Only two economic evaluations provided data to compare bosentan versus sildenafil, and the results favored the use of sildenafil in PAH patients. Four studies compared bosentan with conventional, supportive, or palliative therapy, and whether bosentan was cost-effective was uncertain. Conclusions: Bosentan may represent a more cost-effective option compared with epoprostenol and conventional or palliative therapy. There was unanimous agreement that bosentan was not a cost-effective front-line therapy compared with sildenafil and other endothelin receptor antagonists. However, high-quality cost-effectiveness analyses that utilize long-term follow-up data and have no conflicts of interest are still needed.


Assuntos
Bosentana/uso terapêutico , Antagonistas dos Receptores de Endotelina/uso terapêutico , Hipertensão Pulmonar/tratamento farmacológico , Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Bosentana/economia , Análise Custo-Benefício , Antagonistas dos Receptores de Endotelina/economia , Epoprostenol/análogos & derivados , Epoprostenol/uso terapêutico , Humanos , Fenilpropionatos/economia , Fenilpropionatos/uso terapêutico , Piridazinas/economia , Piridazinas/uso terapêutico , Citrato de Sildenafila/uso terapêutico , Vasodilatadores/economia , Vasodilatadores/uso terapêutico
17.
BMC Public Health ; 18(1): 1282, 2018 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-30458754

RESUMO

INTRODUCTION: Medication co-payments represent a financial barrier to antihypertensive medication adherence. The introduction of co-payments for Irish publically insured patients was associated with a 5% reduction in adherence. However there is socioeconomic variability within this population, and the impact may be greater for those on lower income. We evaluated medication-related financial burden of the co-payment in a cohort of Irish publically insured antihypertensive users and tested its association with adherence at 12 months. METHODS: This was a prospective cohort study of community dwelling older (> 65 yrs) adults (n = 1152) from 106 Irish community pharmacies. Participants completed a structured telephone interview at baseline, and a follow-up interview at 12-months, which we linked to pharmacy records. We assessed medication-related financial burden at baseline using a single questionnaire item, and adherence at 12 months via questionnaire and refill-adherence as Proportion of Days Covered (PDC). RESULTS: A third of participants (30.1%) reported financial burden due to medication costs. In adjusted linear regression models financially burdened participants had significantly lower self-reported adherence (ß = - 0.29, 95% CI -0.48 to - 0.11), although this was not evident with PDC (ß = - 2.76, 95% CI -5.65 to 0.14). CONCLUSION: This co-payment represents a financial barrier to antihypertensive adherence for many older Irish publically insured patients. The negative impact to adherence will potentially increase the risk of adverse outcomes, such as stroke, and increase long-term healthcare costs.


Assuntos
Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Custo Compartilhado de Seguro , Adesão à Medicação/estatística & dados numéricos , Honorários por Prescrição de Medicamentos , Idoso , Feminino , Humanos , Hipertensão/tratamento farmacológico , Cobertura do Seguro , Irlanda , Masculino , Programas Nacionais de Saúde , Estudos Prospectivos
18.
J Med Econ ; 21(12): 1246-1253, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30280614

RESUMO

AIMS: Hypertension is the strongest modifiable risk factor for cardiovascular disease, affecting 80 million individuals in the US and responsible for ∼360,000 deaths, at total annual costs of $93.5 billion. Antihypertension therapies guided by single genotypes are clinically more effective and may avert more adverse events than the standard of care of layering anti-hypertensive drug therapies, thus potentially decreasing costs. This study aimed to determine the economic benefits of the implementation of multi-gene panel guided therapies for hypertension from the payer perspective within a 3-year time horizon. MATERIALS AND METHODS: A simulation analysis was conducted for a panel of 10 million insured patients categorized clinically as untreated, treated but uncontrolled, and treated and controlled over a 3-year treatment period. Inputs included research data; empirical data from a 11-gene panel with known functional, heart, blood vessel, and kidney genotypes; and therapy efficacy and safety estimates from literature. Cost estimates were categorized as related to genetic testing, evaluation and management, medication, or adverse events. RESULTS: Multi-gene panel guided therapy yielding savings of $6,256,607,500 for evaluation and management, $908,160,000 for medications, and $37,467,508,716 for adverse events, after accounting for incremental genetic testing costs of $2,355,540,000. This represents total 3-year savings of $42,276,736,216, or a 47% reduction, and 3-year savings of $4,228 and annual savings of $1,409 per covered patient. CONCLUSIONS: A precision medicine approach to genetically guided therapy for hypertension patients using a multi-gene panel reduced total 3-year costs by 47%, yielding savings exceeding $42.3 billion in an insured panel of 10 million patients. Importantly, 89% of these savings are generated by averting specific adverse events and, thus, optimizing choice of therapy in function of both safety and efficacy.


Assuntos
Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/genética , Farmacogenética/métodos , Adulto , Idoso , Anti-Hipertensivos/administração & dosagem , Simulação por Computador , Análise Custo-Benefício , Feminino , Genótipo , Gastos em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Fatores de Risco
20.
J Clin Hypertens (Greenwich) ; 20(10): 1496-1503, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30238630

RESUMO

Despite the availability of efficient therapies to reduce the risk of cardiovascular complications, poor adherence to antihypertensive (anti-HTN) drugs is frequent, especially during the first year of treatment and among uncontrolled/resistant hypertensive patients. The aim of the study was to identify factors associated with adherence to anti-HTN treatment and to examine whether they differ across sex. A total of 2743 treated hypertensive participants to the cross-sectional Metascope survey (France, 2015) aged 55 years or more were included. The authors measured adherence to anti-HTN treatment using the 6-item Girerd compliance test. Variations in adherence were examined using the Rao-Scott statistics and Poisson regression. Overall, 63.6% of participants were adherent to anti-HTN treatment. Adherence was more frequent among women than men (69% vs 58%, P < 10-4 ). For both sexes, level of adherence was positively associated with age (P < 10-4 ), but inversely associated with number of anti-HTN tablets, number of tablets taken for metabolic diseases, history of cardiovascular diseases, number of other chronic diseases (all P < 10-4 ). The inverse relationship between adherence and the number of anti-HTN tablets significantly differed between sexes (P < 10-4 ): Adherence decreased sharply when taking two or more anti-HTN tablets in men, whereas the decrease in women was only observed when taking three or more anti-HTN tablets. This study suggests that adherence to anti-HTN treatment is higher among women, decreases with the number of tablets prescribed, and differentially so across sex. Reducing the number of tablets for anti-HTN treatment may improve adherence, especially among men and patients with multiple comorbidities.


Assuntos
Doenças Cardiovasculares/epidemiologia , Hipertensão/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Caracteres Sexuais , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/prevenção & controle , Comorbidade , Estudos Transversais , Feminino , França/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Comprimidos/provisão & distribução , Comprimidos/uso terapêutico
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