Dosage of angiotensin-II receptor blockers in heart failure patients following changes in Danish drug reimbursement policies

Christian Selmer; Morten Lamberts; Søren Lund Kristensen; Lene Mia von Kappelgaard; Lars Køber; Gunnar Hilmar Gislason; Christian Torp-Pedersen

doi:10.1002/pds.3670

Dosage of angiotensin-II receptor blockers in heart failure patients following changes in Danish drug reimbursement policies

Christian Selmer, Morten Lamberts, Søren Lund Kristensen, Lene Mia von Kappelgaard, Lars Køber, Gunnar Hilmar Gislason, Christian Torp-Pedersen

Department of Clinical Medicine

Abstract

PURPOSE: National reimbursement policies in Denmark were changed in November 2010 favouring a shift in angiotensin-II receptor blocker (ARB) treatment to generic losartan for heart failure (HF) patients. We examined how changes in reimbursement policies affected the fraction of HF patients up-titrated to optimal or suboptimal ARB dosage.

METHODS: A historical cohort study was performed including HF patients with at least one prescription of ARB in the months of May-Jul 2010 (baseline). Patients were considered up-titrated at doses 100, 16 or 160 mg for losartan, valsartan and candesartan, respectively. Individual-level linkage of nationwide registries of hospitalization and drug dispensing in Denmark was used to describe patterns of ARB prescriptions and estimate dosage before and after November 2010. Logistic regression models were used to assess the probability for being up-titrated in the period.

RESULTS: Of 6036 individuals included (mean age 73.5 [standard deviation 11.2] years; 51% males), 3346 (55.4%) used losartan, 541 (9.0%) valsartan and 2149 (35.6%) candesartan at inclusion, respectively. 2887 (47.8%) were up-titrated at baseline (May-Jul 2010), followed by 2878 (48.2%) in the three months before the policy change (Aug-Oct 2010), and 2492 (43.7%) in the first months after the policy change (Feb-Apr 2011). Odds ratios for being up-titrated according to time period were 1.02 [0.95-1.09] in Aug-Oct 2010 (before policy change) and 0.84 [0.78-0.90] in Feb-Apr 2011 (after policy change), compared with May-Jul 2010 (reference).

CONCLUSION: Probability of being up-titrated in ARB treatment was reduced 20% following changes in drug reimbursement policies.

Original language	English
Journal	Pharmacoepidemiology and Drug Safety
Volume	23
Issue number	12
Pages (from-to)	1281–1287
Number of pages	7
ISSN	1053-8569
DOIs	https://doi.org/10.1002/pds.3670
Publication status	Published - 1 Dec 2014

Access to Document

10.1002/pds.3670

Cite this

Dosage of angiotensin-II receptor blockers in heart failure patients following changes in Danish drug reimbursement policies. / Selmer, Christian; Lamberts, Morten; Kristensen, Søren Lund et al.

In: Pharmacoepidemiology and Drug Safety, Vol. 23, No. 12, 01.12.2014, p. 1281–1287.

Research output: Contribution to journal › Journal article › Research › peer-review

@article{210a5cb443cf4293adf9be455560b0af,

title = "Dosage of angiotensin-II receptor blockers in heart failure patients following changes in Danish drug reimbursement policies",

abstract = "PURPOSE: National reimbursement policies in Denmark were changed in November 2010 favouring a shift in angiotensin-II receptor blocker (ARB) treatment to generic losartan for heart failure (HF) patients. We examined how changes in reimbursement policies affected the fraction of HF patients up-titrated to optimal or suboptimal ARB dosage.METHODS: A historical cohort study was performed including HF patients with at least one prescription of ARB in the months of May-Jul 2010 (baseline). Patients were considered up-titrated at doses 100, 16 or 160 mg for losartan, valsartan and candesartan, respectively. Individual-level linkage of nationwide registries of hospitalization and drug dispensing in Denmark was used to describe patterns of ARB prescriptions and estimate dosage before and after November 2010. Logistic regression models were used to assess the probability for being up-titrated in the period.RESULTS: Of 6036 individuals included (mean age 73.5 [standard deviation 11.2] years; 51% males), 3346 (55.4%) used losartan, 541 (9.0%) valsartan and 2149 (35.6%) candesartan at inclusion, respectively. 2887 (47.8%) were up-titrated at baseline (May-Jul 2010), followed by 2878 (48.2%) in the three months before the policy change (Aug-Oct 2010), and 2492 (43.7%) in the first months after the policy change (Feb-Apr 2011). Odds ratios for being up-titrated according to time period were 1.02 [0.95-1.09] in Aug-Oct 2010 (before policy change) and 0.84 [0.78-0.90] in Feb-Apr 2011 (after policy change), compared with May-Jul 2010 (reference).CONCLUSION: Probability of being up-titrated in ARB treatment was reduced 20% following changes in drug reimbursement policies.",

author = "Christian Selmer and Morten Lamberts and Kristensen, {S{\o}ren Lund} and {von Kappelgaard}, {Lene Mia} and Lars K{\o}ber and Gislason, {Gunnar Hilmar} and Christian Torp-Pedersen",

note = "Copyright {\textcopyright} 2014 John Wiley & Sons, Ltd.",

year = "2014",

month = dec,

day = "1",

doi = "10.1002/pds.3670",

language = "English",

volume = "23",

pages = "1281–1287",

journal = "Pharmacoepidemiology and Drug Safety",

issn = "1053-8569",

publisher = "JohnWiley & Sons Ltd",

number = "12",

}

TY - JOUR

T1 - Dosage of angiotensin-II receptor blockers in heart failure patients following changes in Danish drug reimbursement policies

AU - Selmer, Christian

AU - Lamberts, Morten

AU - Kristensen, Søren Lund

AU - von Kappelgaard, Lene Mia

AU - Køber, Lars

AU - Gislason, Gunnar Hilmar

AU - Torp-Pedersen, Christian

PY - 2014/12/1

Y1 - 2014/12/1

N2 - PURPOSE: National reimbursement policies in Denmark were changed in November 2010 favouring a shift in angiotensin-II receptor blocker (ARB) treatment to generic losartan for heart failure (HF) patients. We examined how changes in reimbursement policies affected the fraction of HF patients up-titrated to optimal or suboptimal ARB dosage.METHODS: A historical cohort study was performed including HF patients with at least one prescription of ARB in the months of May-Jul 2010 (baseline). Patients were considered up-titrated at doses 100, 16 or 160 mg for losartan, valsartan and candesartan, respectively. Individual-level linkage of nationwide registries of hospitalization and drug dispensing in Denmark was used to describe patterns of ARB prescriptions and estimate dosage before and after November 2010. Logistic regression models were used to assess the probability for being up-titrated in the period.RESULTS: Of 6036 individuals included (mean age 73.5 [standard deviation 11.2] years; 51% males), 3346 (55.4%) used losartan, 541 (9.0%) valsartan and 2149 (35.6%) candesartan at inclusion, respectively. 2887 (47.8%) were up-titrated at baseline (May-Jul 2010), followed by 2878 (48.2%) in the three months before the policy change (Aug-Oct 2010), and 2492 (43.7%) in the first months after the policy change (Feb-Apr 2011). Odds ratios for being up-titrated according to time period were 1.02 [0.95-1.09] in Aug-Oct 2010 (before policy change) and 0.84 [0.78-0.90] in Feb-Apr 2011 (after policy change), compared with May-Jul 2010 (reference).CONCLUSION: Probability of being up-titrated in ARB treatment was reduced 20% following changes in drug reimbursement policies.

AB - PURPOSE: National reimbursement policies in Denmark were changed in November 2010 favouring a shift in angiotensin-II receptor blocker (ARB) treatment to generic losartan for heart failure (HF) patients. We examined how changes in reimbursement policies affected the fraction of HF patients up-titrated to optimal or suboptimal ARB dosage.METHODS: A historical cohort study was performed including HF patients with at least one prescription of ARB in the months of May-Jul 2010 (baseline). Patients were considered up-titrated at doses 100, 16 or 160 mg for losartan, valsartan and candesartan, respectively. Individual-level linkage of nationwide registries of hospitalization and drug dispensing in Denmark was used to describe patterns of ARB prescriptions and estimate dosage before and after November 2010. Logistic regression models were used to assess the probability for being up-titrated in the period.RESULTS: Of 6036 individuals included (mean age 73.5 [standard deviation 11.2] years; 51% males), 3346 (55.4%) used losartan, 541 (9.0%) valsartan and 2149 (35.6%) candesartan at inclusion, respectively. 2887 (47.8%) were up-titrated at baseline (May-Jul 2010), followed by 2878 (48.2%) in the three months before the policy change (Aug-Oct 2010), and 2492 (43.7%) in the first months after the policy change (Feb-Apr 2011). Odds ratios for being up-titrated according to time period were 1.02 [0.95-1.09] in Aug-Oct 2010 (before policy change) and 0.84 [0.78-0.90] in Feb-Apr 2011 (after policy change), compared with May-Jul 2010 (reference).CONCLUSION: Probability of being up-titrated in ARB treatment was reduced 20% following changes in drug reimbursement policies.

U2 - 10.1002/pds.3670

DO - 10.1002/pds.3670

M3 - Journal article

C2 - 24962821

SN - 1053-8569

VL - 23

SP - 1281

EP - 1287

JO - Pharmacoepidemiology and Drug Safety

JF - Pharmacoepidemiology and Drug Safety

IS - 12

ER -

Dosage of angiotensin-II receptor blockers in heart failure patients following changes in Danish drug reimbursement policies

Abstract

Access to Document

Fingerprint

Cite this