Effect of medication burden on persistent use of lipid-lowering drugs among patients with hypertension
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Teisha A Robertson1, Catherine E Cooke, Jingshu Wang
1School of Pharmacy, University of Maryland, Baltimore, MD, USA. ttay1002@umaryland.edu
Insights
Higher medication burden in patients with hypertension correlates with increased adherence to newly added lipid-lowering drugs. Clinicians should not hesitate to prescribe these essential therapies.
Area of Science:
- Pharmacoeconomics
- Cardiovascular Health
- Medication Adherence Research
Background:
- Hypertension management often involves multiple medications.
- Lipid-lowering (LL) drug initiation is common in cardiovascular care.
- Understanding factors influencing LL therapy persistence is crucial.
Purpose of the Study:
- To investigate the relationship between medication burden and persistent use of newly initiated lipid-lowering drugs.
- To assess the impact of the number of concurrent medications on adherence to LL therapy in hypertensive patients.
Main Methods:
- Retrospective analysis of medical and pharmacy claims data from 2003-2005.
- Cohort of 3058 patients with hypertension and newly added LL prescriptions.
- Analysis of medication burden (number of unique drug products) and its association with LL therapy persistence and medication possession ratio (MPR) over 18 months.
Main Results:
- A higher medication burden was significantly associated with increased persistence to LL therapy (P < .001).
- Patients with greater medication burden demonstrated higher medication possession ratios (MPR >80%), indicating better adherence (P < .001).
- The average medication burden in the study cohort was 2.9 medications.
Conclusions:
- Increased medication burden positively impacts adherence to newly added lipid-lowering therapies.
- Clinicians should not be deterred from prescribing LL drugs due to a patient's existing medication regimen.
- Focus should be placed on patients experiencing changes in their LL regimen, rather than those maintaining consistent therapy.
Objective:
To determine the effect of medication burden on persistent use of newly added lipid-lowering (LL) drugs among patients with hypertension.
Study Design:
This retrospective database study used medical and pharmacy claims from a mid-Atlantic managed care organization. The cohort was obtained from continuous member enrollment in pharmacy and medical benefits from January 1, 2003, to December 31, 2005.
Methods:
Prescription claims were obtained for 18 months following the date of the first filled LL prescription (ie, index date). Patients were stratified into patients who changed LL drug or strength (group 1) and patients who did not change LL drug or strength (group 2). The primary outcome measure was persistence to newly added LL therapy. Persistence was defined by the length of time a member remained on therapy following the index date. The secondary outcome measure was the medication possession ratio (MPR). The MPR was calculated as the ratio of the sum of the days' supply of prescription filled divided by the number of days filled, plus the days' supply for the final prescription fill. Associations between the daily medication burden, defined as the number of unique drug products, and the outcome measures were analyzed.
Results:
In the cohort of 3058 patients, the mean medication burden was 2.9 medications. Medication burden was positively associated with persistence and MPR through 18 months. Patients who had greater medication burden had longer persistence (P <.001). Likewise, patients who had greater medication burden had higher MPRs and were more likely to be considered adherent (MPR, >80%) (P < .001 for both).
Conclusions:
Patients with higher medication burden had greater adherence to newly added LL therapy. Medication burden should not deter clinicians from adding LL therapy. Among patients with added LL therapy, more attention should focus on patients who have changes to their LL regimen compared with patients who continue on the same LL prescription.
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