Prescription data related to the use of calcium channel blockers, ace inhibitors and angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) in combination identify saving opportunities

Background: It is now recognized that treating hypertension with combination therapy is required to achieve target blood pressure in the majority of patients. Objective: To investigate the use of ACE inhibitors, angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) and calcium channel blockers (CCBs) within the Lombardia Region of Italy and to evaluate associated financial implications of the use of these drugs in free combinations. Methods: Prescription data in the Administrative National Health Service (NHS) Reimbursement Database of the Lombardia Region (2004-6) were analysed for ACE inhibitor, ARB and CCB use. Data included patient code, prescription date, drug class, product license number, number of packs dispensed and actual expenditure reimbursed by the NHS, and were used to calculate the mean daily cost of free combination antihypertensive treatments. Results: ACE inhibitors, ARBs or CCBs were prescribed at least once to 1.6 million patients (17% of Lombardia population) either as single therapy (51.5% of patients receiving these drugs) or in combination therapy (48.5%). mong patients who received these drugs, 22.5% received free combination therapy (primarily ACE inhibitor plus CCB or ARB plus CCB). The mean annual cost for these drugs was h342 million, representing 18% of the total annual pharmaceutical expenditure for the region. Free combinations accounted for 14.3% of treatment days, but 28.3% of annual expenditure for these drugs. Further analysis revealed that the mean expenditure for free combinations was 2.6-31.9% higher than the sum of their individual component costs (mean increase of 5.9% for the most commonly prescribed free combinations). Conclusions: Prescription of free combination of antihypertensive drugs is associated with additional financial burden to the NHS, which may be avoided by prescribing fixed combination therapy.