Effect of a single pill concept on clinical and pharmacoeconomic outcomes in cardiovascular diseases

Abstract

Aims: Our study aimed to assess whether a single pill concept (SPC) is superior to a multi-pill concept (MPC) in reducing cardiovascular (CV) events, all-cause death, and costs in CV patients.

Method and results: Anonymized medical claims data covering 2012-2018, including patients with hypertension, dyslipidaemia, and CV diseases who started a drug therapy either as SPC or identical MPC were analysed after 1:1-propensity score matching. Hospitalizations with predefined CV events, all-cause mortality, and costs were studied in 25 311 patients with SPC and 25 311 patients with MPC using incidence rate ratios (IRRs) and non-parametric tests for continuous variables.IRRs were significantly lower for SPC: stroke (IRR = 0.77; 95% CI 0.67-0.88; P < 0.001), transitory ischaemic attack (IRR = 0.61; 95% CI 0.48-0.78; P < 0.001), myocardial infarction (IRR = 0.76; 95% CI 0.63-0.90; P = 0.0016), coronary artery disease (IRR = 0.66; 95% CI 0.57-0.77; P < 0.001), heart failure (IRR = 0.59; 95% CI 0.54-0.64; P < 0.001), acute renal failure (IRR = 0.54; 95% CI 0.56-0.64; P < 0.001), all cause hospitalization (IRR = 0.72; 95% CI 0.71-0.74; P < 0.001), CV hospitalization (IRR = 0.63; 95% CI 0.57-0.69; P < 0.001), and all-cause mortality (IRR = 0.62; 95% CI 0.57-0.68; P < 0.001). Mean time to first events and time to death were also in favour of SPC. Mean total costs were 4708€ for SPC vs. 5.669€ for MPC, respectively (mean ratio 0.830, P < 0.001).

Conclusion: SPC is associated with lower incidence rates of CV events, time to CV events, and all-cause death, and is superior regarding pharmacoeconomic parameters and should therefore become standard of care to improve outcomes and reduce healthcare costs.

Keywords: Adherence; Arterial hypertension; Cardiovascular disorders; Cardiovascular outcomes; Dyslipidemia; Single pill concept.

Graphical Abstract

Figure 1

Patient flow. Figure 1 highlights the consort flow diagram.

Figure 2

Time to non-persistence. Figure 2 shows the proportion of patients persistent to medication over the observational period. Comparisons are done between matched SPC vs. MPC cohorts.

Figure 3

Event rates per treatment group. Figure 3 shows the number of all-cause mortality, myocardial infarction, stroke, transitory ischaemic attack, coronary artery disease, heart failure, acute/chronic renal failure per observed 100 patient years in the respective cohorts. Comparisons are done between matched SPC vs. MPC cohorts.

Figure 4

Time to first Event. Figure 4 shows the proportion of patients that are event free over the observational period. Events that were observed were hospitalizations with diagnosis of myocardial infarction, stroke, transitory ischaemic attack, coronary artery disease, heart failure, acute and chronic renal failure, any cardiovascular hospitalization, all cause hospitalization, all-cause mortality. Comparisons are done between matched SPC vs. MPC cohorts.

Figure 5

Time to death. Figure 5 shows the proportion of patients surviving over the observational period. Comparisons are done between matched SPC vs. MPC cohorts. Patients were followed up from index date until one of the following events, whatever came first: End of data availability (30 July 2018), all-cause death, therapy discontinuation defined as gap in drug supply of at least 60 days, based on the defined daily dose (DDD) per agent, in case of a MPC a gap of 60 days for at least one of the combination agents led to censoring in that respect, switch from SPC to MPC or vice versa.