Real-world analysis on drug utilization, cardiovascular hospitalization and healthcare costs of patients on single pill vs free combination of perindopril/bisoprolol in italy

Objective: The present real-world analysis aims to compare the drug utilization, CV hospitalizations and healthcare direct costs related to the use of single-pill combination (SPC) or free-combination of perindopril/bisoprolol (PER/BIS) in a large Italian population. Design and method: This observational retrospective analysis was based on administrative databases covering approximately 7 million subjects across Italy. All adult subjects receiving PER/BIS as SPC or free combination between January 2017-June 2020 were included. Subjects were followed for 1 year after the first prescription of PER/BIS as free-combination ( ± 1 month) or SPC. Before comparing the SPC and free-combination cohorts, propensity score matching (PSM) was applied to balance the baseline characteristics. Adherence was defined by proportion of days covered (PDC) and time to treatment discontinuation (evaluated by Kaplan-Meier curves). Given that the SPC PER/BIS can be taken as half a tablet a day, the PDC was calculated assuming the prescription of one tablet/day or half tablet/day. Mean annual healthcare direct costs were analyzed as overall drugs, hospitalizations and outpatient services costs during follow-up. Results: The original cohort included 11,440 and 6,521 patients taking the SPC and free PER/BIS combination, respectively. After PSM, two balanced SPC and free-combination cohorts of 4,688 patients were obtained (mean age 70 years, approximately 50% male). Proportion of adherent patients (PDC > = 80%) was higher for those on SPC (45.5% and 76.3% assuming one SPC/day or half SPC/day, respectively) than those on free-combination (38.6%), p < 0.001. The PER/BIS combination was discontinued by 35.8% in SPC cohort and 41.7% of patients in the free-combination cohort (p < 0.001, Figure 1A). The SPC cohort had less cardiovascular (CV) hospitalizations (5.3%) and shorter CV hospital admissions (0.4 ± 2.3 days) than the free-combination cohort (7.4% and 0.6 ± 2.9 days), p < 0.001 for both comparisons (Figure 1B). Mean annual total healthcare costs were lower in the SPC (1,999€) than in the free-combination (2,359€) cohort (details on cost items are presented in Figure 1B). Conclusions: Patients treated with PER/BIS SPC have higher adherence, lower risk of drug discontinuation, reduced risk of CV hospitalization, and lower healthcare costs than those on free-combination.