Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2015, 24(1):5-18

Influence of regulations on antihypertensives' utilization in Slovakia

Pšenková M, Mackovičová S, Marčišová M, Ondrušová M
Pharm-In, spol. s r.o. v Bratislave, Slovenská republika

Aim: The aim of this paper is to assess potential relationships between introduction of regulations in drug policy and the utilization of antihypertensives, health insurance companies' expenditures and financial participation of patients. With regard to the persistent problem of low adherence to treatment, those relationships that might affect the adherence to treatment of patients were analyzed in particular.

Methods: The IMS Data database was used as a basis for the assessment of utilization and cost of antihypertensives. In this database the utilization is expressed as DOT (days of treatment) and financial turnover (in €). In order to assess the cost of treatment in diagnosis of essential hypertension (ICD-10: I10) the IMS Medical Index was used, which reflects the trends in drugs prescription in Slovak clinical practice. Data about the patient's copayment were assessed based on data obtained from National Health Information Centre (NHIC). The average copayment for one packet of drugs was calculated using the weighted average method.

Results: Within last 10 years the prices of drugs, reimbursement and patient's copayment have changed significantly as a result of regulations in drug policy. These regulations have influenced the utilization and costs of antihypertensive therapy. The utilization of antihypertensives has increased over there longterm, probably as a result of population aging and increasing prevalence of essential hypertension. Despite these increases in utilization the expenditures for antihypertensives were stabilized in 2009 and since 2012 have even decreased. In the observed period 2006-2013 the final price of antihypertensives decreased in average by 23% and health insurance companies' participation decreased by 35%, which led to the increase in the patient's copayment by 43%. This increase was more obvious in fixed combinations of antihypertensives than in their individual components. While in the case of monocomponents the average increase of patient's copayment increased by 18%, in the case of fix combinations the increase was 166%. Patient's copayment for one pack of fixed antihypertensive drug in 2013 was on average 1.24 € higher compared to a free combination of two drugs. Simultaneously, when the interannual development of antihypertensives utilization is compared, a shift in prescription from a fixed combination to free combinations is obvious.

Conclusions: Our results suggest that regulations in health policy influence the utilization of antihypertensives and cost of hypertension treatments significantly. The most important regulations that affect the decision regarding drugs' reimbursement were implemented just three years ago and the trends identified in this paper need to be analyzed over longer time. Better understanding of relationship between regulations in health policy and utilization of drugs could help in the evaluation of the impact of implemented regulations on the management of hypertension and may also help in decision making related to regulations of hypertension treatment financing.

Keywords: antihypertensives; utilization; costs; patient's copayment; law; regulations

Published: January 1, 2015  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Pšenková M, Mackovičová S, Marčišová M, Ondrušová M. Influence of regulations on antihypertensives' utilization in Slovakia. Cardiology Letters. 2015;24(1):5-18.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Snincak M, Balazovjech I, Machacova E, et al. Tlak krvi na Slovensku. Prevalencia hypertenzie, povedomie, liečba a jej efektivita v reprezentatívnom stratifikovanom súbore. KESHSR 2004. Vnitř Lék 2005;51:1184-1185.
    2. Avdicova M, Hruba F, Konevicova T, Namesna J. Výskyt rizikových faktorov srdcovo-cievnych a nádorových ochorení v modelovej oblasti Banská Bystrica a Trebišov. Surveillance chronických ochorení v Slovenskej republike. CINDI program v SR; 2005: 37-51.
    3. Barakova A. Vybrané informácie zo zdravotníckej štatistiky o vývoji chorôb obehovej sústavy v SR. ŠZU v spolupráci s UZIaŠ. Bartislava. Projekt MONIKA; 2002:66.
    4. Filipova S, Dukat A, Foltan V, Gajdosik J, Jonas P. Artériová hypertenzia. Štandardný diagnostický a terapeutický postup. 59. metodický list racionálnej farmakoterapie 2014;17(1-3):1-16.
    5. Law M, Wald N, Morris J. Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy. Health Technol Assess. 2003;7(31):1-94. Go to original source...
    6. Zdravotnícka ročenka Slovenskej republiky 2012. Národné centrum zdravotníckych informácií, Bratislava 2014. ISBN 978-80-89292-35-6. [online]. Dostupné na internete: www. nczi.sk.
    7. Národný program prevencie ochorení srdca a ciev. [online] Dostupné na internete: www.uvzsr.sk/docs/info/podpora/NPPOC. pdf.
    8. Buchow H, Cayotte E, Agafite L. Populations and social conditions. Eurostat. Statistics in focus 2012(7):4.
    9. OECD. OECD Health Data 2012. 28 jún 2012. Dostupné na internete: <http://www.oecd.org/health/health-systems/oecdhealthdata2013.htm>.
    10. Studencan M, Kovar F, Hricak V, Kurray P, Goncalvesova E, Kamensky G. Aktuálne trendy v starostlivosti o pacientov so STEMI v Slovenskej republike. Analýza výsledkov registra SLOVAKS-2 z roku 2011. Cardiol Lett 2013;22(2):115-124.
    11. Psenkova M, Paluch A. Nákladovosť vybraných kardiovaskulárnych príhod a ich komplikácií pre účely modelovania nákladovej efektivity antikoagulačnej liečby. Farmakoekonomika a lieková politika 2010;8(4):3-8.
    12. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. ESH/ESC Guidelines for the management of arterial hypertension. The Task Force of the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31(7):1281-1357. Go to original source...
    13. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, et al. Selected major risk factors and global and regional burden of disease. Lancet 2002;360(9343):1347-1360. Go to original source...
    14. Pereira M, Lunet N, Azevedo A, Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens 2009;27(5):963-975. Go to original source...
    15. Burnier M, Schneider MP, Chioléro A, Stubi CL, Brunner HR. Electronic compliance monitoring in resistant hypertension: the basis for rational therapeutic decisions. J Hypertens 2001;19(2):335-41. Go to original source...
    16. Leenen FHH, Wilson TW, Bolli P, Larochelle P, Mayers M, Handa SP, et al. Patterns of compliance with once versus twice daily antihypertensive drug therapy in primary care: a randomized clinical trial using electronic monitoring. Can J Cardiol 1997;13(10) 914-920.
    17. Schroeder K, Fahey T, Ebrahim S. Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Collaboration 2004;2:CD004804. Go to original source...
    18. Mennini FS, Marcellusi JM, Schulenburg JM, Gray A, Levy P, Sciattella P, et al. Cost of poor adherence to anti-hypertensive therapy in five European countries. Eur J Health Econ Jan 2014. Go to original source...
    19. Schlenk EA, Burke LE, Rand C. Behavioral strategies to improve medication-taking compliance. In: Burke LE, Ockene IS, eds. Compliance in Healthcare and Research, Armonk, NY; Futura Publishing Co: 2001:57-70.
    20. Monane M, Bohn RL, Gurwitz JH, Glynn EJ, Levin R, Avorn J. The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in the elderly. Am J Hypertens. 1997;10(7 Pt 1):697-704. Go to original source...
    21. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003/289 2560-2572. Go to original source...
    22. Sokol MC, McGuigan KA, Verbrugge RR. Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost. Med Care 2005;43(6):521-530. Go to original source...
    23. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology. (ESC). J Hypertens 2007;25(6):1105-1187. Go to original source...
    24. Thoenes M, Neuberger HR, Volpe M, Khan BV, Kirch W, Bohm M. Antihypertensive drug therapy and blood pressure control in men and women: an international perspective. J Hum Hypertens 2010;24(5):336-344. Go to original source...
    25. Erdine S. How do compliance, convenience, and tolerability affect blood pressure goal rates? Am J Cardiovasc Drugs 2012;12(5):295-302. Go to original source...
    26. Claxton AJ, Cramer J, Pierce J. A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001;23(8):1296-1310. Go to original source...
    27. Sherrill B, Halpern M, Khan S, Zhang J, Panjabi S. Single-pill vs free-equivalent combination therapies for hypertension: a metaanalysis of health care costs and adherence. J Clin Hypertens 2011;13(12):898-909. Go to original source...
    28. Bangalore S, Kamalakkannan G, Parkar S, Messertli FH. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med 2007;120(8):713-719. Go to original source...
    29. Taylor AA, Shoheiber O. Adherence to antihypertensive therapy with fixed-dose amlodipine besylate/benazepril HCl versus comparable component-based regimen. Congest Heart Fail 2003;9(6):324-332. Go to original source...
    30. Gerbino PP, Shoheiber O. Adherence patterns among patients treated with fixed-dose combination versus separate antihypertensive agents. Am J Health Syst Pharm 2007;64(12):1279-1283. Go to original source...
    31. Dezii CM. A retrospective study of persistence with single-pill combination therapy vs. concurrent two-pill therapy in patients with hypertension. Manag Care 2000;9(9):S2-S6.
    32. Jackson JH, Sobolski J, Krienke R, Wong KS, Frech-Tamas F, Nightengale B. Blood pressure control and pharmacotherapy patterns in the United States before and after the release of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment. of High Blood Pressure (JNC 7) Guidelines. J Am Board Fam Med 2008;21(6):512-521. Go to original source...
    33. EHIS 2009 - Európske zisťovanie o zdraví 2009. Štatistický úrad SR, 2011. Dostupné na internete:http://portal.statistics.sk/ files/Sekcie/sek_600/Socialne_statistiky/Socialne_statistiky/ EHIS_2009/ehis_2009_verzia_pre_portal-su-sr.pdf.
    34. Psenkova, M, Mackovicova S. Liek v systéme - cesta kategorizačným procesom. Farmakoekonomika a lieková politika 2013;9(2):35-39.
    35. Clark AM, DesMeules M, Luo W, Duncan AS, Wielgosz A. Socioeconomic status and cardiovascular disease: risk and implications for care. Nat Rev Card 2009;6(11):712-722. Go to original source...
    36. Mann BS, Barnieh L, Tang K, et al. Association between Drug Insurance Cost Sharing Strategies and Outcomes in Patients with Chronic Diseases: A Systematic Review. PLoS ONE 2014;9(3):e89168. Go to original source...
    37. Maciejewski ML, Farley JF, Parker J, et al. Copayment Reductions Generate Greater Medication Adherence In Targeted Patients. Health Aff 2010;29(11):2002-2008. Go to original source...
    38. Pesa JA, Van Den Bos J, Gray T, Hartsig C, McQueen RB, Saseen JJ, et al. An evaluation of the impact of patient cost sharing for antihypertensive medications on adherence, medication and health care utilization, and expenditures. Patient Prefer and Adherence 2012;(6):63-72. Go to original source...
    39. Yoon J, Ettner SL. Cost sharing and adherence to antihypertensives for low and high adherers. Am J Manag Care 2009;15(11):833840.
    40. Chernew ME, Shah MR, Wegh A, Rosenberg SN, Juster IA, Rosen AB, et al. Impact of decreasing copayments on medication adherence within a disease management environment. Health Aff 2008;27(1):103-112. Go to original source...
    41. Maciejewski ML, Bryson CL, Perkins M, Blough DK, Cunningham FE, Fortney JC, et al. Incre Pharm-In, spol. s r.o., City Business Center V, Karadžičova 16, 821 08 Bratislava. E-mailová adresa: maria.psenkova@pharmin.sk. Tel.: 0905-949 473asing copayments and adherence to diabetes, hypertension, and hyperlipidemic medications. Am J Manag Care 2010;16(1):e20-e34.

    Return to the content