Caracterización y costes asociados al perfil del paciente con diabetes tipo 2 en tratamiento con metformina al que se le añade un segundo fármaco antidiabético oral: estudio de base poblacional / Characterization of and costs associated to the profile of patients with type 2 diabetes treated with metformin who are added a second oral antidiabetic drug: a population study

OBJETIVOS: Determinar el cumplimiento, control metabólico, complicaciones y costes sanitarios de los pacientes tratados con metformina que iniciaron un segundo fármaco antidiabético en pacientes con diabetes tipo 2 (DM2).Pacientes y métodos; Diseño observacional-multicéntrico de carácter retrospectivo. Se evaluaron pacientes de edad igual o superior a 30 años, en tratamiento con metformina y que iniciaron un segundo tratamiento antidiabético durante 2008-2009. Se establecieron 4 grupos de pacientes (metformina y otro antidiabético): a) inhibidores de la dipeptidil peptidasa 4 (IDPP4); b) sulfonilureas; c) glitazonas, y d) insulinas. Principales medidas: comorbilidad, control metabólico, cumplimiento y complicaciones. El seguimiento se realizó durante 2 años. El modelo de costes diferenció los costes sanitarios directos (atención primaria/especializada) e indirectos (productividad laboral). Análisis estadístico: modelos de regresión logística y ANCOVA, p < 0,05. RESULTADOS: Se seleccionaron 2.067 pacientes (edad media: 66,6 años; varones: 53,1%). Un 25,1% iniciaron un segundo tratamiento con IDPP4; 42,9% con sulfonilureas, 14,0% con glitazonas, y 18,0% con insulinas. A los 2 años de seguimiento, los pacientes tratados con IDPP4 mostraron un mayor cumplimiento terapéutico (70,3 vs. 59,9%, 60,3% y 58,4); mejor control de la DM2 (64,3 vs. 62,6%, 62,8 y 50,5%) y menor proporción de hipoglucemias (13,9 frente a 40,4%, 37,6% y 58,9%, respectivamente) (p < 0,001). El promedio/unitario de los costes totales fue de 2.321 € frente a 2.475 €, 2.724 €, y 3.164 €, respectivamente; p < 0,001. Las tasas de eventos cardiovasculares e insuficiencia renal fueron del 3,7; 6,4; 7,6, y 10,2%, respectivamente. CONCLUSIONES: Las sulfonilureas fueron los fármacos más utilizados. Los pacientes en tratamiento con IDPP4 presentaron mayor cumplimiento y control de la diabetes, con menores tasas de hipoglucemias y costes sanitarios

OBJECTIVES: To determine compliance, metabolic control, complications and healthcare costs of patients treated with metformin started a second antidiabetic drug in patients with type 2 diabetes (T2DM). PATIENTS AND METHODS: Design multicenter observational retrospective. Patients were evaluated ≥30 years (age), treated with metformin and started a second antidiabetic treatment during 2008-2009. There were 4 patient groups (metformin and another antidiabetic): a) dipeptidyl peptidase-4 inhibitors (IDPP4), b) sulfonylureas, c) glitazones and d) insulin. Main measures: comorbidity, metabolic control, compliance and complications. Patients were followed for 2 years. The cost model differed direct health costs (primary care / specialist) and indirect (labor productivity). Statistical analysis: logistic regression models and ANCOVA, p < 0.05. RESULTS: 2067 patients were included (mean age: 66.6 years male: 53.1%). 25.1% started a second treatment with IDPP4; 42.9% sulfonylureas, 14.0% glitazones and 18.0% insulin. At 2 years follow-up, patients treated with IDPP4 showed greater adherence vs. 70.3%. 59.9%, 60.3% and 58.4; better control of 64.3% vs. DM2. 62.6%, 62.8% and 50.5% and a decrease of 13.9% compared to hypoglycaemia 40.4%, 37.6% and 58.9% respectively (p < 0.001). The average / unit total costs was €2,321 vs. €2,475, €2,724 and €3,164, respectively, p < 0.001. Rates of cardiovascular events and renal failure were 3.7%, 6.4%, 7.6% and 10.2% respectively. CONCLUSIONS: Sulfonylureas were the most commonly used drugs. Patients treated with IDPP4 had higher compliance and control of diabetes, with lower rates of hypoglycaemia and healthcare costs

[Characterization of and costs associated to the profile of patients with type 2 diabetes treated with metformin who are added a second oral antidiabetic drug: a population study]. / Caracterización y costes asociados al perfil del paciente con diabetes tipo 2 en tratamiento con metformina al que se le añade un segundo fármaco antidiabético oral: estudio de base poblacional.

OBJECTIVES: To determine compliance, metabolic control, complications and healthcare costs of patients treated with metformin started a second antidiabetic drug in patients with type 2 diabetes (T2DM). PATIENTS AND METHODS: Design multicenter observational retrospective. Patients were evaluated ≥30 years (age), treated with metformin and started a second antidiabetic treatment during 2008-2009. There were 4 patient groups (metformin and another antidiabetic): a) dipeptidyl peptidase-4 inhibitors (IDPP4), b) sulfonylureas, c) glitazones and d) insulin. MAIN MEASURES: comorbidity, metabolic control, compliance and complications. Patients were followed for 2 years. The cost model differed direct health costs (primary care / specialist) and indirect (labor productivity). STATISTICAL ANALYSIS: logistic regression models and ANCOVA, p<0.05. RESULTS: 2067 patients were included (mean age: 66.6 years male: 53.1%). 25.1% started a second treatment with IDPP4; 42.9% sulfonylureas, 14.0% glitazones and 18.0% insulin. At 2 years follow-up, patients treated with IDPP4 showed greater adherence vs. 70.3%. 59.9%, 60.3% and 58.4; better control of 64.3% vs. DM2. 62.6%, 62.8% and 50.5% and a decrease of 13.9% compared to hypoglycaemia 40.4%, 37.6% and 58.9% respectively (p<0.001). The average / unit total costs was €2,321 vs. €2,475, €2,724 and €3,164, respectively, p<0.001. Rates of cardiovascular events and renal failure were 3.7%, 6.4%, 7.6% and 10.2% respectively. CONCLUSIONS: Sulfonylureas were the most commonly used drugs. Patients treated with IDPP4 had higher compliance and control of diabetes, with lower rates of hypoglycaemia and healthcare costs.

Relación entre la polimedicación y el control de la presión arterial: cumplimiento, persistencia, costes e incidencia de nuevos eventos cardiovasculares / Relationship of polymedication in controlling blood pressure: compliance, persistence, costs and incidence of new cardiovascular events

FUNDAMENTO Y OBJETIVO: Determinar la relación entre la polifarmacia y el control de la presión arterial (PA), el cumplimiento, la persistencia, el coste y la incidencia de episodios cardiovasculares (ECV) en pacientes con hipertensión moderada/grave. Pacientes y métodos: Diseño observacional-multicéntrico de carácter retrospectivo. Se evaluaron pacientes > 30 años que iniciaron un tercer tratamiento antihipertensivo durante 2004-2006. Según el número de medicamentos crónicos, se establecieron 3 grupos: consumo regular de 3-6 fármacos, entre 7-10 y ≥ 11. Principales-medidas: sociodemográficas, comorbilidad, presión arterial, cumplimiento y persistencia. Para cada grupo se determinaron la incidencia de nuevos ECV y los costes totales. El seguimiento se realizó durante 4 años. Resultados: Se evaluaron 1.906 pacientes; 765 tomaban entre 3-6 fármacos; 624 entre 7-10 y 517 ≥ 11 (p < 0,001). La edad media fue de 69,4 años y el 55,5% eran mujeres. El grupo de 3-6 fármacos mostró mejor control de la PA (51,8 frente a 47,0 y 41,1%; p < 0,001), cumplimiento (71,4 frente a 69,9 y 67,1%; p = 0,017), persistencia (50,1 frente a 45,5 y 46,2%; p = 0,044) y menor incidencia de ECV (12,2 frente a 19,7 y 30,2%; p < 0,001), respectivamente. El promedio/unitario de los costes totales fue de 3.369,1, frente a 4.362,1 y 4.902,3 € (p < 0,001). La presencia de ECV se asoció al incumplimiento terapéutico (odds ratio [OR] 1,9, intervalo desconfianza del 95% [IC 95%] 1,1-3,6) y al bajo control de la PA (OR 1,4, IC 95% 1,1-2,0) (p < 0,05). El uso de antihipertensivos a dosis fijas conlleva mayor cumplimiento (72,8 frente a 68,2%), persistencia (64,4 frente a 39,3%) y grado de control de la PA (52,6 frente a 43,8%) (p < 0,001). Conclusiones: La polifarmacia se asocia a menor cumplimiento y persistencia del tratamiento antihipertensivo, con aumento de ECV y costes sanitarios

BACKGROUND AND OBJECTIVE: To determine the relationship of polypharmacy on blood pressure (BP) control, compliance, persistence, the cost and incidence of cardiovascular events (CVD) in patients with moderate/severe hypertension. PATIENTS AND METHODS: An observational multicenter retrospective study. We evaluated patients > 30 years who started a third antihypertensive treatment during 2004-2006. Depending on the number of chronic medications, we established 3 groups: regular consumption of 3-6 drugs, including between 7-10 and ≥11. Top-measures: sociodemographic, comorbidity, BP, compliance and persistence. For each group we determined the incidence of new CVD totals and total costs. RESULTS: We evaluated 1,906 patients, 765 between 3-6 drugs, 624 between 7-10 and 517 in ≥ 11 (P < .001). Overage age: 69.4 years and 55.5% women. The group of 3-6 drugs showed better BP control (51.8 vs. 47.0 and 41.1%, P < .001), compliance (71.4 vs. 69.9 and 67.1%, P = .017), persistence (50.1 vs. 45.5 and 46.2%, P = .044) and lower incidence of CVD (12.2 vs. 19.7 and 30.2%, P < .001), respectively. The average/unit total costs was 3,369.1 vs. 4,362.1 and € 4,902.3 (P < .001). The presence of CVD was associated with therapy noncompliance (odds ratio [OR] 1.9, 95% confidence interval [95%CI] 1.1 to 3.6) and controlled by the lower BP control (OR 1.4 (95%CI 1.1-2.0) (P < .05). The use of antihypertensive fixed dose has greater compliance (72.8 vs. 68.2%), persistence (64.4 vs. 39.3%) and degree of BP control (52.6 vs. 43, 8%) (p < .001). CONCLUSIONS: Polypharmacy is associated with lower compliance and persistence to antihypertensive treatment, cardiovascular disease and increased health care costs

[Relationship of polymedication in controlling blood pressure: compliance, persistence, costs and incidence of new cardiovascular events]. / Relación entre la polimedicación y el control de la presión arterial: cumplimiento, persistencia, costes e incidencia de nuevos eventos cardiovasculares.

BACKGROUND AND OBJECTIVE: To determine the relationship of polypharmacy on blood pressure (BP) control, compliance, persistence, the cost and incidence of cardiovascular events (CVD) in patients with moderate/severe hypertension. PATIENTS AND METHODS: An observational multicenter retrospective study. We evaluated patients > 30 years who started a third antihypertensive treatment during 2004-2006. Depending on the number of chronic medications, we established 3 groups: regular consumption of 3-6 drugs, including between 7-10 and ≥ 11. Top-measures: sociodemographic, comorbidity, BP, compliance and persistence. For each group we determined the incidence of new CVD totals and total costs. RESULTS: We evaluated 1,906 patients, 765 between 3-6 drugs, 624 between 7-10 and 517 in ≥ 11 (P<.001). Overage age: 69.4 years and 55.5% women. The group of 3-6 drugs showed better BP control (51.8 vs. 47.0 and 41.1%, P<.001), compliance (71.4 vs. 69.9 and 67.1%, P=.017), persistence (50.1 vs. 45.5 and 46.2%, P=.044) and lower incidence of CVD (12.2 vs. 19.7 and 30.2%, P<.001), respectively. The average/unit total costs was 3,369.1 vs. 4,362.1 and € 4,902.3 (P<.001). The presence of CVD was associated with therapy noncompliance (odds ratio [OR] 1.9, 95% confidence interval [95%CI] 1.1 to 3.6) and controlled by the lower BP control (OR 1.4 (95%CI 1.1-2.0) (P < .05). The use of antihypertensive fixed dose has greater compliance (72.8 vs. 68.2%), persistence (64.4 vs. 39.3%) and degree of BP control (52.6 vs. 43, 8%) (p<.001). CONCLUSIONS: Polypharmacy is associated with lower compliance and persistence to antihypertensive treatment, cardiovascular disease and increased health care costs.