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Rahman ARA, Magno JDA, Cai J, Han M, Lee HY, Nair T, Narayan O, Panyapat J, Van Minh H, Khurana R. Management of Hypertension in the Asia-Pacific Region: A Structured Review. Am J Cardiovasc Drugs 2024; 24:141-170. [PMID: 38332411 PMCID: PMC10973088 DOI: 10.1007/s40256-023-00625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/10/2024]
Abstract
This article reviews available evidence regarding hypertension management in the Asia-Pacific region, focussing on five research questions that deal with specific aspects: blood pressure (BP) control, guideline recommendations, role of renin-angiotensin-aldosterone system (RAAS) inhibitors in clinical practice, pharmacological management and real-world adherence to guideline recommendations. A PubMed search identified 2537 articles, of which 94 were considered relevant. Compared with Europeans, Asians have higher systolic/diastolic/mean arterial BP, with a stronger association between BP and stroke. Calcium channel blockers are the most-commonly prescribed monotherapy in Asia, with significant variability between countries in the rates of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and single-pill combination (SPC) use. In clinical practice, ARBs are used more commonly than ACEis, despite the absence of recommendation from guidelines and clinical evidence supporting the use of one class of drug over the other. Ideally, antihypertensive treatment should be tailored to the individual patient, but currently there are limited data on the characteristics of hypertension in Asia-Pacific individuals. Large outcome studies assessing RAAS inhibitor efficacy and safety in multi-national Asian populations are lacking. Among treated patients, BP control rates were ~ 35 to 40%; BP control in Asia-Pacific is suboptimal, and disproportionately so compared with Western nations. Strategies to improve the management of hypertension include wider access/availability of affordable treatments, particularly SPCs (which improve adherence), effective public health screening programs targeting patients to drive health-seeking behaviours, an increase in physician/patient awareness and early implementation of lifestyle changes. A unified Asia-Pacific guideline on hypertension management with pragmatic recommendations, particularly in resource-limited settings, is essential.
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Affiliation(s)
- Abdul R A Rahman
- An Nur Specialist Hospital, Jalan Gerbang Wawasan 1, Seksyen 15, 43650, Bandar Baru Bangi, Selangor, Malaysia.
| | - Jose Donato A Magno
- Division of Cardiovascular Medicine, Philippine General Hospital, Cardiovascular Institute, University of the Philippines College of Medicine, Angeles University Foundation Medical Center, Angeles, Philippines
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, Beijing, People's Republic of China
| | - Myint Han
- Grand Hantha International Hospital, Yangon, Myanmar
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro Chongno-gu, Seoul, 03080, South Korea
| | - Tiny Nair
- PRS Hospital, Trivandrum, Kerala, India
| | - Om Narayan
- The Northern Hospital, 185 Cooper St., Epping, VIC, 3122, Australia
| | - Jiampo Panyapat
- Bhumibol Adulyadej Hospital, 171 Paholyothin Road, Saimai, Bangkok, 10220, Thailand
| | - Huynh Van Minh
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue, 530000, Vietnam
| | - Rohit Khurana
- The Harley Street Heart and Vascular Center, Gleneagles Hospital, Singapore, 258500, Singapore
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Paoli CJ, Linder J, Gurjar K, Thakur D, Wyckmans J, Grieve S. Effectiveness of Single-Tablet Combination Therapy in Improving Adherence and Persistence and the Relation to Clinical and Economic Outcomes. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2024; 11:8-22. [PMID: 38500521 PMCID: PMC10948140 DOI: 10.36469/001c.91396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 03/20/2024]
Abstract
Background: Single-tablet combination therapies (STCTs) combine multiple drugs into one formulation, making drug administration more convenient for patients. STCTs were developed to address concerns with treatment adherence and persistence, but the impact of STCT use is not fully understood across indications. Objectives: We conducted a systematic literature review (SLR) to examine STCT-associated outcomes across 4 evidence domains: clinical trials, real-world evidence (RWE), health-related quality of life (HRQoL) studies, and economic evaluations. Methods: Four SLRs were conducted across the aforementioned domains. Included studies compared STCTs as well as fixed-dose combinations ([FDCs] of non-tablet formulations) with the equivalent active compounds and doses in loose-dose combinations (LDCs). Original research articles were included; case reports, case series, and non-English-language sources were excluded. Databases searched included EconLit, Embase, and Ovid MEDLINE® ALL. Two independent reviewers assessed relevant studies and extracted data. Conflicts were resolved with a third reviewer or consensus-based discussion. Results: In all, 109 studies were identified; 27 studies were identified in more than one SLR. Treatment adherence was significantly higher in patients receiving FDCs vs LDCs in 12 of 13 RWE studies and 3 of 13 clinical trials. All 18 RWE studies reported higher persistence with FDCs. In RWE studies examining clinical outcomes (n = 17), 14 reported positive findings with FDCs, including a reduced need for add-on medication, blood pressure control, and improved hemoglobin A1C. HRQoL studies generally reported numerical improvements with STCTs or similarities between STCTs and LDCs. Economic outcomes favored STCT use. All 6 cost-effectiveness or cost-utility analyses found FDCs were less expensive and more efficacious than LDCs. Four budget impact models found that STCTs were associated with cost savings. Medical costs and healthcare resource use were generally lower with FDCs than with LDCs. Discussion: Evidence from RWE and economic studies strongly favored STCT use, while clinical trials and HRQoL studies primarily reported similarity between STCTs and LDCs. This may be due to clinical trial procedures aimed at maximizing adherence and HRQoL measures that are not designed to evaluate drug administration. Conclusions: Our findings highlight the value of STCTs for improving patient adherence, persistence, and clinical outcomes while also offering economic advantages.
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Affiliation(s)
- Carly J. Paoli
- Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey, USA
| | - Jörg Linder
- Janssen-Cliag of Johnson & Johnson, Neuss, Germany
| | | | | | - Julie Wyckmans
- Janssen Pharmaceutical Companies of Johnson & Johnson, Basel, Switzerland
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Cui Z, Qiu Z, Cheng W, Hu W, Ma G, Cai X, Jin Y, Zhao Y, He L, Li Y, Bu P, Chen X, Wang R, Chen L, Dong P, Feng L, Han X, Hong M, Hou Y, Liao M, Wang M, Wang X, Xie J, Xu Y, Wang Z, Huang K, Li Y, Li D, Ji X, Huang J, Wang J, Fang D, Wang J, Tang L, Liu Y, Fu G, Du J, Wang L, Liu M, Ge J. Efficacy and safety of olmesartan medoxomil-amlodipine besylate tablet in Chinese patients with essential hypertension: A prospective, single-arm, multi-center, real-world study. J Clin Hypertens (Greenwich) 2024; 26:5-16. [PMID: 37667532 PMCID: PMC10795096 DOI: 10.1111/jch.14700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 09/06/2023]
Abstract
There lacks real-world study with a large sample size assessing olmesartan medoxomil-amlodipine besylate (OM-AML) tablet. Therefore, this study aimed to evaluate the efficacy and safety of OM-AML tablet in patients with essential hypertension. Totally, 1341 patients from 36 medical centers with essential hypertension who took OM-AML (20/5 mg) tablet were analyzed in the current prospective, single-arm, multi-center, real-world study (SVK study). Seated systolic blood pressure (SeSBP) and seated diastolic blood pressure (SeDBP) at baseline, week (W)4 and W8 were measured. The mean (±SE) change of SeSBP/SeDBP was -10.8 ± 0.4/-6.6 ± 0.3 mmHg at W4 and -12.7 ± 0.5/-7.6 ± 0.3 mmHg at W8, respectively. At W4, 78.8% and 29.0% patients achieved BP target by China and American Heart Association (AHA) criteria; at W8, 84.7% and 36.5% patients reached blood pressure (BP) target by China and AHA criteria, accordingly. Meanwhile, 80.2% and 86.4% patients achieved BP response at W4 and W8, respectively. Home-measured SeSBP and SeDBP decreased from W1 to W8 (both p < .001). Besides, patients' and physicians' satisfaction were elevated at W8 compared with W0 (both p < .001). The medication possession rate was 94.8% from baseline to W4 and 91.3% from baseline to W8. The most common drug-related adverse events were nervous system disorders (4.6%), vascular disorders (2.6%), and general disorders and administration site conditions (2.3%) by system organ class, which were generally mild and manageable. In conclusion, OM-AML tablet is one of the best antihypertensive agents in patients with essential hypertension.
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Affiliation(s)
- Zhaoqiang Cui
- Department of CardiologyZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Zhaohui Qiu
- Department of CardiologyShanghai Tongren HospitalShanghaiChina
| | - Wenli Cheng
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Wei Hu
- Department of CardiologyCentral Hospital of Minhang DistrictShanghaiChina
| | - Genshan Ma
- Department of CardiologyZhongda Hospital Affiliated to Southeast UniversityNanjingChina
| | - Xiaojun Cai
- Department of CardiologyJinan Central HospitalJinanChina
| | - Yafei Jin
- Department of CardiologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Yi Zhao
- Department of CardiologyDalian Jinzhou First People's HospitalDalianChina
| | - Liqun He
- Department of CardiologyWuhan No. 1 HospitalWuhanChina
| | - Ying Li
- Department of CardiologyShanghai East HospitalShanghaiChina
| | - Peili Bu
- Department of CardiologyQilu Hospital of Shandong UniversityJinanChina
| | - Xiaoping Chen
- Department of CardiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Ruxing Wang
- Department of CardiologyWuxi People's HospitalWuxiChina
| | - Lin Chen
- Department of CardiologyThird Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Peng Dong
- Department of CardiologyBeijing Aviation General HospitalBeijingChina
| | - Liuliu Feng
- Department of CardiologyShidong Hospital, Yangpu DistrictShanghaiChina
| | - Xuebin Han
- Department of CardiologyShanxi Cardiovascular Hospital (Shanxi Cardiovascular Diseases Institute)TaiyuanChina
| | - Mei Hong
- Department of CardiologyThe Second Clinical Medical College of Nanjing Medical UniversityNanjingChina
| | - Yinglong Hou
- Department of CardiologyThe First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan HospitalJinanChina
| | - Minlei Liao
- Department of CardiologyBaoshan Branch, Shanghai General HospitalShanghaiChina
| | - Mingliang Wang
- Department of CardiologyPutuo People's Hospital, Tongji UniversityShanghaiChina
| | - Xiaoyan Wang
- Department of CardiologyWuxi Third People's HospitalWuxiChina
| | - Jianhong Xie
- Department of CardiologyZhejiang Provincial People's HospitalHangzhouChina
| | - Yawei Xu
- Department of CardiologyShanghai Tenth People's HospitalShanghaiChina
| | - Zhenxing Wang
- Department of CardiologyJiangsu Province Hospital of Chinese MedicineNanjingChina
| | - Kai Huang
- Department of CardiologyUnion Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Yongle Li
- Department of CardiologyTianjin Medical University General HospitalTianjinChina
| | - Dongsheng Li
- Department of CardiologyWuhan Third HospitalWuhanChina
| | - Xiaojun Ji
- Department of CardiologyWenzhou Central HospitalWenzhouChina
| | - Jing Huang
- Department of CardiologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jun Wang
- Department of CardiologyJing'an District Central Hospital of ShanghaiShanghaiChina
| | - Danhong Fang
- Department of CardiologyThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Jian'an Wang
- Department of CardiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Lijiang Tang
- Department of CardiologyZhejiang HospitalHangzhouChina
| | - Yingwu Liu
- Department of CardiologyTianjin Third Central HospitalTianjinChina
| | - Guosheng Fu
- Department of CardiologySir Run Run Shaw Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Juan Du
- Medical DepartmentDaiichi Sankyo (China) Holdings Co., LtdShanghaiChina
| | - Ling Wang
- Medical DepartmentDaiichi Sankyo (China) Holdings Co., LtdShanghaiChina
| | - Mengqi Liu
- Medical DepartmentDaiichi Sankyo (China) Holdings Co., LtdShanghaiChina
| | - Junbo Ge
- Department of CardiologyZhongshan Hospital, Fudan UniversityShanghaiChina
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Liang L, Shao T, Li H, Zhao M, Tang W. Cost-effectiveness and potential budget impact of non-pharmacological interventions for early management in prehypertensive people: an economic evaluation for China. BMC Public Health 2023; 23:1531. [PMID: 37568086 PMCID: PMC10416408 DOI: 10.1186/s12889-023-16458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Non-pharmacological interventions (NPIs) could be considered in the early management of prehypertensive population. This study aimed to evaluate the potential cost-effectiveness of NPIs and the budget impact of implementing NPIs on prehypertensive population in China and provide evidence of chronic disease management innovation for decision-makers. METHODS Five NPIs including usual care, lifestyle, strengthen exercise, relaxation, and diet therapy were selected based on the practice of hypertension management in China. A nine-state Markov model was constructed to evaluate the lifetime costs and health outcomes of five NPIs and a non-intervention group from the perspective of Chinese healthcare system. The effectiveness of NPIs was obtained from a published study. Parameters including transition probabilities, costs and utilities were extracted or calculated from published literature and open-access databases. Sensitivity analyses were conducted to test the uncertainty of all parameters. The impact of duration of intervention was considered in scenario analyses. A budget impact analysis (BIA) was conducted to evaluate the total cost and the medical cost saving of a hypothetical nationwide implementation of potential cost-effective NPI in prehypertensive people. Management strategies including focusing on patients with specific ages or different CVE risk levels, and different duration of implementation were taken into consideration. RESULTS Strengthen exercise was the most cost-effective intervention with a probability of 78.1% under the given WTP threshold. Our results were sensitive to the cost of interventions, and the utility of prehypertension and hypertension. The duration of implementation had limited impact on the results. BIA results showed that the program cost was hefty and far more than the medical cost saving with the course of simulation time. Applying management strategies which focused on individual characteristics could largely reduce the program cost despite it remained higher than medical cost saving. CONCLUSIONS Strengthen exercise was a potential NPI that can be considered in priority for early management in prehypertensive population. Although early management can acquire medical cost saving, the related program cost can be quite hefty. Precise strategies which may help reduce the cost of early management should be taken into consideration in program design.
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Affiliation(s)
- Leyi Liang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Taihang Shao
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Hao Li
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Mingye Zhao
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Wenxi Tang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China.
- Department of Public Affairs Management, School of International Pharmaceutical Business, Pharmaceutical University, 211198, Nanjing, China.
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Dong X, He X, Wu J. Cost Effectiveness of the First-in-Class ARNI (Sacubitril/Valsartan) for the Treatment of Essential Hypertension in a Chinese Setting. PHARMACOECONOMICS 2022; 40:1187-1205. [PMID: 36071264 DOI: 10.1007/s40273-022-01182-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study was to model the potential long-term disease progression and pharmacoeconomic value of sacubitril/valsartan for the treatment of essential hypertension from a Chinese healthcare system perspective. METHODS A Markov cohort model with five health states was constructed to simulate the incidence of acute cardiovascular events and cost per quality-adjusted life-year (QALY) gained with sacubitril/valsartan compared with allisartan isoproxil and valsartan over a lifetime horizon with an annual cycle. Multivariable risk regression models derived from China-PAR data accompanied by hazard ratios were used to transform the dual mechanism of sacubitril/valsartan to lower blood pressure and left ventricular mass index into long-term fatal and non-fatal cardiovascular risks. Efficacy data were calculated using a network meta-analysis integrated by the results of clinical trials. Healthcare costs were determined from a real-world study and published literature, supplemented by expert opinion. Utilities were derived from literature. Both costs and health outcomes were discounted at 5.0% annually, and prices corresponded to 2021. Model validation, deterministic and probabilistic sensitivity analyses were conducted to test the robustness of results. RESULTS For simulated patients with hypertension, sacubitril/valsartan reduced the rates of myocardial infarction by 6.67% and 6.39%, stroke by 9.38% and 8.98%, and heart failure hospitalization by 9.92% and 9.62% relative to allisartan isoproxil and valsartan, respectively. It was also associated with gains in life expectancy among hypertensive individuals of 0.362-0.382 years. Eventually, lifetime costs per patient were CN¥59,272 (US$9187) for sacubitril/valsartan, CN¥54,783 (US$8492) for allisartan isoproxil, and CN¥56,714 (US$8791) for valsartan; total QALYs were 11.38, 11.24, and 11.25, respectively. The incremental cost-effectiveness ratio was CN¥31,805/QALY (US$4930/QALY) compared with allisartan isoproxil, and CN¥19,247/QALY (US$2983/QALY) compared with valsartan, both of which are below the one time per-capita GDP of CN¥80,976/QALY (US$12,551/QALY) in China. Similar results were obtained in various extensive sensitivity analysis scenarios. CONCLUSIONS This was the first study to evaluate the cost effectiveness of sacubitril/valsartan in the treatment of hypertension. Sacubitril/valsartan compares favorably with allisartan isoproxil and valsartan in the Chinese setting, which is mainly due to its higher efficacy resulting in fewer cardiovascular events and ultimately less related mortality over time. The results could inform deliberations regarding reimbursement and access to this treatment in China and may provide reference for facilitating more reasonable and efficient allocation of limited resources in such low- and middle-income countries.
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Affiliation(s)
- Xinyue Dong
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
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Lou Y, Yu Y, Liu J, Huang J. Sacubitril-valsartan for the treatment of hypertension in China: A cost-utility analysis based on meta-analysis of randomized controlled trials. Front Public Health 2022; 10:959139. [PMID: 36062091 PMCID: PMC9432800 DOI: 10.3389/fpubh.2022.959139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Background Sacubitril-valsartan was recommended for heart failure (HF) and proven cost-effective in HF. Recently, sacubitril-valsartan has been recommended to treat hypertension by the Chinese expert consensus. The cost utility of sacubitril-valsartan for hypertension remains uninvestigated. Methods A meta-analysis of randomized controlled trials (RCTs) was performed to investigate the real efficacy of sacubitril-valsartan on blood pressure, compared with angiotensin receptor blockers or placebo. A lifetime Markov model was developed to compare the cost utility of sacubitril-valsartan vs. valsartan. The primary outcome was the incremental cost-utility ratio (ICUR), representing the ratio of incremental costs to the incremental utility. The willingness-to-pay (WTP) threshold was three times of per capita gross domestic product (GDP) in China in 2021. Sacubitril-valsartan was considered cost-effective if the ICUR obtained was lower than the WTP threshold, otherwise, sacubitril-valsartanis was not cost-effective. Results A total of 10 RCTs of 5,781 patients were included in the meta-analysis. For comparison of sacubitril-valsartan 400 mg/day vs. valsartan 320 mg/day, a reduction in blood pressure (BP) of -5.97 (-6.38, -5.56) (p < 0.01) was observed. Cost-utility analysis showed that for a 60-year-old patient with hypertension, if sacubitril-valsartan was prescribed as the antihypertensive agent, he had a life expectancy of 11.91 quality-adjusted life-years (QALYs) with costs of 65,066 CNY, and if valsartan was prescribed as the antihypertensive agent, the life expectancy would be 11.82 QALY with costs of 54,769 CNY; thus, an ICUR of 108,622 CNY/QALY was obtained, lower than the WTP threshold. Conclusion Compared with valsartan, sacubitril-valsartan is more effective in reducing blood pressure and may result in more quality-adjusted life-year, although with higher costs. Sacubitril-valsartan is cost-effective for hypertension in the current China setting under the willingness-to-pay threshold of 3 times of per capita GDP.
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Affiliation(s)
- Yake Lou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinxing Liu
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Huang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Incze A, Kaló Z, Espín J, Kiss É, Kessabi S, Garrison LP. Assessing the Consequences of External Reference Pricing for Global Access to Medicines and Innovation: Economic Analysis and Policy Implications. Front Pharmacol 2022; 13:815029. [PMID: 35462921 PMCID: PMC9019924 DOI: 10.3389/fphar.2022.815029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background: External reference pricing (ERP) is used to set pharmaceutical prices to improve affordability, but its application may have negative consequences on patient access—thus, equity—across countries and on global innovation. With the United States contemplating ERP, negative effects could be magnified. Our aim: identify and quantify some major consequences of ERP. Research design, methods: Besides relying on databases and ERP modelling, we developed a heart failure case study. 4-step approach: 1) review ERP policies; 2) establish worldwide “price corridor”; 3) quantify patient access and health outcomes impact by ERP; 4) estimate ERP impact on innovation. Results: Our ERP referencing analysis highlights its perverse effects especially in lower-income countries. As counterstrategies to protect their revenues, manufacturers often implement tight list price corridors or launch avoidance/delays. Consequences include suboptimal patient access—hence, worse outcomes—illustrated by our case study: 500,000 + QALYs health loss. Additionally, the ensuing revenue reduction would likely cause innovation loss by one additional medicine that would have benefitted future patients. Conclusion: This research provides key insights on potential unintentional consequences of medicine price setting by ERP worldwide and under a new proposal for the United States. Our results can inform stakeholder discussions to improve patient access to innovative medicines globally.
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Affiliation(s)
- András Incze
- Department of Healthcare Management, Baden-Wuerttemberg Cooperative State University, Loerrach, Germany.,Akceso Advisors AG, Basel, Switzerland
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University/Syreon Research Institute, Budapest, Hungary.,Syreon Research Institute, Budapest, Hungary
| | - Jaime Espín
- Andalusian School of Public Health, Granada, Spain
| | - Éva Kiss
- Akceso Advisors AG, Basel, Switzerland
| | | | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute Department of Pharmacy, University of Washington, Seattle, WA, United States
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Paczkowska-Walendowska M, Sip S, Staszewski R, Cielecka-Piontek J. Single-Pill Combination to Improve Hypertension Treatment: Pharmaceutical Industry Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4156. [PMID: 35409840 PMCID: PMC8999086 DOI: 10.3390/ijerph19074156] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/10/2022]
Abstract
Multiple illness is an increasingly common phenomenon. Its consequence is the need for polytherapy, which is particularly common among people suffering from arterial hypertension. The development of combined preparations (containing at least two API-active pharmaceutical ingredients) dedicated to the treatment of hypertension is a response to increased compliance, especially in elderly patients. In our work, we describe in particular the possibilities of using β-adrenergic receptors blockers and angiotensin-converting enzyme inhibitors in combinations. The combinations of APIs are used as single pills in patients with arterial hypertension with concomitant diseases such as hyperlipidemia; blood coagulation problems and diabetes mellitus were also discussed successively. Pharmacoeconomic analysis for the API combinations shown is also presented. As a final conclusion, numerous benefits of using the combined preparations should be indicated, especially by the elderly and/or in patients with coexistence of other diseases.
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Affiliation(s)
| | - Szymon Sip
- Department of Pharmacognosy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (M.P.-W.); (S.S.)
| | - Rafał Staszewski
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Długa 1/2, 61-848 Poznań, Poland;
| | - Judyta Cielecka-Piontek
- Department of Pharmacognosy, Poznan University of Medical Sciences, Rokietnicka 3, 60-806 Poznan, Poland; (M.P.-W.); (S.S.)
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Zhang ZY, Yu YL, Asayama K, Hansen TW, Maestre GE, Staessen JA. Starting Antihypertensive Drug Treatment With Combination Therapy: Controversies in Hypertension - Con Side of the Argument. Hypertension 2021; 77:788-798. [PMID: 33566687 PMCID: PMC7884241 DOI: 10.1161/hypertensionaha.120.12858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Zhen-Yu Zhang
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (Z.-Y.Z., Y.-L.Y., K.A.)
| | - Yu-Ling Yu
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (Z.-Y.Z., Y.-L.Y., K.A.)
| | - Kei Asayama
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (Z.-Y.Z., Y.-L.Y., K.A.)
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A.)
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A.)
- Research Institute Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium (K.A., G.E.M., T.W.H., J.A.S)
| | - Tine W. Hansen
- Research Institute Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium (K.A., G.E.M., T.W.H., J.A.S)
- Steno Diabetes Center Copenhagen, Capital Region of Denmark, Denmark (T.W.H.)
| | - Gladys E. Maestre
- Research Institute Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium (K.A., G.E.M., T.W.H., J.A.S)
- Department of Neurosciences and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX (G.E.M.)
- Alzheimer´s Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX (G.E.M.)
| | - Jan A. Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium (K.A., G.E.M., T.W.H., J.A.S)
- Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Belgium (J.A.S.)
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