Retrospective analysis of total direct medical costs associated with hepatitis B patients with oral antiviral versus pegylated interferon therapy in Turkey

Economic Impact and Complications of Treated and Untreated Hepatitis C Virus Patients in Turkey

BACKGROUND

According to the Turkish Ministry of Health's guidelines, standard double therapy, a combination of pegylated interferon-alpha and ribavirin, was the only treatment option for patients with hepatitis C virus (HCV) infection until the end of 2011.

OBJECTIVE

The primary objective was to compare risk-adjusted clinical and economic outcomes between treated and untreated patients with HCV infection.

METHODS

Patients with HCV infection were identified from the Turkish National Health Insurance Database (2009-2011) using International Classification of Diseases, 10th Revision, Clinical Modification codes. The first prescription date was designated as the index date. Mortality and hepatocellular carcinoma (HCC) rates and health care costs of treated and untreated patients were compared using propensity score matching. Baseline demographic and clinical factors were controlled in the models. Subgroup analysis was conducted for patient groups with and without a cirrhosis diagnosis.

RESULTS

Out of 12,990 patients included in the study, 1,583 were treated for HCV infection. Out of 2,467 patients who had a cirrhosis diagnosis, 231 were treated, whereas out of 10,523 patients without cirrhosis, 1,352 patients were treated. Treated patients were younger, less likely to be diagnosed with comorbid conditions, and less likely to reside in Central or Eastern Anatolia. After adjusting for baseline demographic and clinical factors, mortality (2.27% vs. 5.31%; P < 0.001) and HCC rates (0.69% vs. 1.96%; P < 0.001) were found to be lower for treated patients. Differences were more significant among patients diagnosed with cirrhosis. Treated patients incurred higher risk-adjusted annual costs (€6172 vs. €1680; P < 0.001), mainly because of pharmaceutical costs (€4918 vs. €583; P < 0.001).

CONCLUSIONS

HCV infection treatment, although costly, significantly reduces mortality and HCC rates in Turkey.

A medication adherence and persistence comparison of hypertensive patients treated with single-, double- and triple-pill combination therapy

OBJECTIVE

Fixed-dose combination therapy reduces pill burden and may, therefore, improve medication adherence and health outcomes. This study compared adherence to and persistence with single-, double-, and triple-pill treatment regimens among hypertensive patients in a US clinical practice setting.

METHODS

Adults with hypertension treated with three anti-hypertensive medications were identified. Index date was the first occurrence of a single-, double-, or triple-pill regimen with olmesartan or valsartan plus amlodipine and hydrochlorothiazide from July 2010 to September 2011. Patients were followed for 12 months to assess adherence (proportion of days covered [PDC] ≥ 80%) and time to discontinuation (medication gap ≥ 60 days) of the index regimen. Multivariate regression models were used to compare adjusted outcomes.

RESULTS

The number of prescribed pills in the index regimen was monotonically related to adherence with 55.3%, 40.4% and 32.6% of patients having PDC ≥ 80% in the single-, double- and triple-pill cohorts, respectively. In adjusted analysis, patients in the double- (odds ratio [OR]: 0.45; 95% confidence interval [CI]: 0.42-0.48) and triple-pill (OR: 0.26; 95% CI: 0.22-0.30) cohorts were less likely to be adherent to their index regimens than those in the single-pill cohort. Double-pill (hazard ratio [HR]: 1.89; 95% CI: 1.74-2.06) and triple-pill patients (HR: 2.49; 95% CI: 2.14-2.88) were more likely to discontinue treatment than single-pill patients.

CONCLUSIONS

Greater pill burden was directly and significantly associated with decreased adherence and persistence with antihypertensive therapies in real-practice settings. Use of fixed-dose combinations that reduce pill burden could help patients to continue treatment and may result in improved clinical outcomes. Typical of observational studies, the potential for residual confounding of adherence estimates remains due to lack of randomization of treatment groups.