Background:
Metoprolol is a commonly prescribed β-blocker for hypertension in the US. Evidence suggests that the vasodilating β1-blocker, nebivolol, is superior to non-vasodilating beta-blockers, such as metoprolol, in lowering central blood pressure, an effect which is thought to be highly correlated to future cardiovascular (CV) risk. The aim of this study was to evaluate CV-related healthcare resource utilization (HCRU) and costs before and after patients switched from metoprolol to nebivolol for hypertension treatment.
Methods:
This retrospective study utilized medical and pharmacy claims from HealthCore-Integrated-Research-Database with 14 US commercial health plans representing over 33 million lives. The study cohort included only patients who were initially taking metoprolol for at least 6 months (pre-period) and then switched to nebivolol and remained on it for at least 6 months (post-period). The date of switching to nebivolol between 1/1/ 2008 and 12/31/2012 was defined as the index date. Patients were excluded if they had angina, myocardial infarction and congestive heart failure (compelling indications for metoprolol but not for nebivolol); unstable regimen of background antihypertensive medication at the drug class level; or did not have continuous health plan enrollment during these two periods. CV-related HCRU (per-100 patient-per-month) and costs (per-patient-per-month (PPPM)) were calculated for pre- and post- periods respectively by type of service - hospitalizations (INP), emergency room (ER) visits, and outpatient (OP) visits. Bootstrapping t-test was used to compare the differences of HCRU and costs between these two periods.
Results:
There were 765 patients included in the study with mean age 55(±11)years, 59% males and mean Deyo-Charlson Comorbidity Index (DCI) score of 0.5(±0.9). Relative to pre-period, the number of CV-related ER visits and CV-related OP visits per-100 patient-per-month were significantly lower in the post-period (ER: 0.17±1.88 vs.0.04±0.84, p=0.012; OP: 9.2±19.9 vs. 6.7±17.5, p<0.001). No differences were observed in number of CV-related INP visits. Additionally, relative to the pre-period, the ER cost and the total CV-related medical were significantly lower in the post-period (ER: $6 ±$78 vs. $1±$27 PPPM, p=0.028; total CV-related medical costs: $94±$526 vs. $54±$266 PPPM, p=0.020). There were no differences found in INP or OP costs.
Conclusions:
This study suggests that hypertensive patients switching from metoprolol to nebivolol have lower CV-related ER and OP visits as well as lower total CV-related medical costs, despite higher pharmacy costs after switching from a generic to a branded drug. Further studies are needed to identify these key drivers.
Adherence, Healthcare Resource Utilization and Direct Medical Costs Among Patients with Alzheimer's Disease in Tianjin, China
