A study published in the Journal of Managed Care & Specialty Pharmacy aimed to assess the healthcare utilization costs associated with various treatment strategies in patients who have had efficacy or tolerance issues with first-line antihypertensive monotherapy.

The researchers conducted a retrospective cohort study using the 2008–2012 BlueCross BlueShield of Texas database to compare the costs associated with efficacy improvement strategies (ie, adding a medication [either free-pill or fixed-dose combinations], gradually increasing the dose of current medication) as well as tolerance strategies (switching to a different drug, gradually decreasing the dose of the current medication). 

Enrolled patients had a treatment modification within 12 months of starting antihypertensive monotherapy. Study authors used propensity score-adjusted generalized linear models to compare data between alternative treatment modification methods. 

A total of 5,998 eligible patients had a treatment modification as follows: free-pill combination (n=1,395), fixed-dose combination (n=1,207), uptitration (n=1,659), switching (n=1,282) and downtitration (n=455). 

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The data showed the highest mean annual drug utilization cost was seen with the fixed-dose combination strategy ($310 per year vs. $135 for switching, $63 for uptitration, and $61 for downtitration), however this strategy was also associated with reduced inpatient services utilization costs related to blood pressure or cardiovascular issues (fixed-dose combos: $1,731, downtitration: $2,985, free-pill combination: $5,746, switching: $7,076, uptitration: $7,692). 

“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,” said lead investigator Kalyani Sonawane, Ph.D. When modifying antihypertensive treatment regimens, clinicians should carefully consider the differences in costs between the strategies.

For more information visit jmcp.org.