Comment
Author: Admin | 2025-04-28
Individual identification code, which allows to trace the healthcare pathway of NHS beneficiaries. To preserve privacy, each identification code is automatically deidentified, the inverse process being only allowed to the Regional Health Authority upon request from judicial authorities. Further details on Healthcare Utilization Databases in our studies and in pharmacoepidemiological studies are available in previous publications [6,13,14]. Cohort selection and follow-up The target population included Lombardy residents, aged 40 years or older, who were beneficiaries of the NHS. Of these, those who received a prescription of a SPC of three BP-lowering drugs between 2015 and 2018 were identified and included in the exposed cohort. The date of the first prescription during this period was defined as the index date. During the study period, only the perindopril/amlodipine/indapamide SPC was available in the Italian market. Patients were excluded if they (i) were not beneficiaries of the NHS for at least 3 years before the index date, (ii) had less than the planned 1 year of follow-up (see below), because of death or change of residence from Lombardy to other regions, and (iii) patients who had only the initial index date prescription, i.e. in whom need for antihypertensive drug treatment was not confirmed. For each patient included in the exposed cohort, a comparator was identified among subjects prescribed a combination of an angiotensin-converting enzyme inhibitor (ACEI), a calcium-channel blocker (CCB), and a diuretic as a two-drug SPC plus a third drug given separately (i.e. 2 pills). The ACEI, CCB and the diuretic were other than perindopril, amlodipine and indapamide in 85, 52, and 99% of the patients, respectively. Patients using triple therapy in a two-drug combination were selected provided that (i) the above-mentioned inclusion and exclusion criteria were satisfied and (ii) the index date fell within ±30 days of the index date of the corresponding three-drug SPC patient. The identified comparators were included in the nonexposed cohort. Patients prescribed the three-drug SPC and the corresponding comparators had also to be prescribed a similar antihypertensive treatment strategy during the year before the index date. The cohort members were followed from the index date for 365 days afterwards. Adherence to and discontinuation of antihypertensive drug therapy For each patient included in the exposed and nonexposed cohorts, all antihypertensive drugs dispensed during the follow-up were identified. Because in our database the prescribed daily doses are not recorded, the period covered by a prescription was calculated by dividing the total amount of the drug prescribed for the defined daily dose. For overlapping prescriptions, the patient was assumed to have taken all the drug(s) contained in the former prescription before starting the latter one. Adherence to antihypertensive drug therapy was assessed by the ratio between the number of
Add Comment