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AbstractObjective:This retrospective patient data analysis was initiated to describe current treatment patterns of patients in Germany with arterial hypertension, with a special focus on compliance, persistence, and medication costs of fixed-dose and unfixed combinations of angiotensin receptor blockers (ARBs), amlodipine (AML) and hydrochlorothiazide (HCT) in Germany.Methods:The study analyzed prescription data collected by general practitioners, using the IMS Disease Analyzer database. The database was searched for patients with the diagnosis hypertension (ICD-10 code I10) and treatment data in the period 09/2009 to 08/2010. Compliance was measured indirectly based on the medication possession ratio (MPR), and persistence was defined as the duration of time from initiation to discontinuation of therapy. Medication costs were assessed from the statutory health insurance perspective in Germany.Results:In the IMS DA 406,888 observable patients in Germany were encoded with the diagnosis I10 essential hypertension. In total, 88,716 patients received prescriptions including ARBs, monotherapy (18.6%) or unfixed combinations with other anti-hypertensives (19.3%). The compliance with fixed-dose combinations of ARB with HCT, either dual or with one other anti-hypertensive drug, was significantly better, compared to unfixed combinations (mean compliance 78.1% for fixed-dose vs 71.5% for unfixed combinations of ARB with HCT, p < 0.0001; mean compliance 79.4% vs 72.0%, p < 0.0001 if an additional anti-hypertensive medication was added). Fixed-dose combinations of ARB with HCT, ARB with AML, dual only or prescribed with another anti-hypertensive medication resulted in a substantial increase of persistence, especially for patients on fixed-dose dual combinations (225.7 vs 163.6 days for ARB with HCT; 232.9 vs 178.4 days for ARB with AML, respectively). Fixed-dose combinations (varying from €1.38 to €2.20 per patient and day) were on average cheaper than unfixed combinations.Limitations:Persistence and compliance could be under- or over-estimated because their assessment was based on prescription information. For two thirds of 69,060 patients, data on compliance and persistence was missing.Conclusion:The study shows considerable variations in ARB treatment patterns among patients, with the majority of patients treated with fixed-dose or semi-fixed combination therapy. Fixed-dose combinations of ARBs with HCT and/or AML seem to result in better compliance and persistence compared to unfixed regimes of these drug classes, leading to reduction in all-cause hospitalizations, emphasizing the benefit and potential cost-savings of using fixed-dose regimes in a real-life general practice setting in Germany.

As of January 2004, a new DRG (diagnosis related groups) based system has been introduced for the reimbursement of hospital services in Germany. As current data on the treatment cost of patients with myocardial infarction (MI), ischaemic stroke (IS), and peripheral arterial occlusive disease (PAD) are lacking from the third-party payer’s perspective, a bottom-up cost analysis was conducted as a first approach to show treatment cost, based on the DRG system. The evaluation is focused on patients who are hospitalized for an initial cardiovascular event, such as MI, IS or PAD. In order to describe the resource utilization following an initial event owing to MI, IS and PAD, an expert panel was convened in 1997, which included cardiologists, neurologists, angiologists, internists and general practitioners (GP). To update the 1997 expert panel resource utilization data, four specialists for atherothrombotic diseases in Germany were interviewed in 2004. Prices and charges for drugs and medical services were adapted to the current payment system. Annual costs and costs for a subsequent 6-month period were calculated. Patients with MI incurred on average 11,672 EUR in the first year after the initial event and 981 EUR in the subsequent 6-month period. Annual costs in the first year in patients with IS and PAD were 17,864 EUR and 7,674 EUR, respectively. Treatment costs for the subsequent 6-month period were 5,280 EUR in IS patients and 1,172 EUR in PAD patients. This is a first approach to outline the longitudinal dimension of treatment costs from the third-party payer’s perspective in patients with MI, IS and PAD, based on the DRG system in Germany.The evaluation provides basic data for further decision-making, including assessment of treatment strategies for MI, IS and PAD in Germany.