目的：从国家和州级层面，在成人高血压患者中比较与单片复方制剂（SPC）vs. 自由联合（FC）治疗相关的依从性/持久性、医疗资源利用和成本。对血管紧张素受体拮抗剂（ARB）+ 钙通道阻滞剂、ARB+氢氯噻嗪以及血管紧张素转换酶抑制剂+氢氯噻嗪联合进行评估。 
    方法：在MarketScan数据库（2006-2008）中找出以SPC或FC为初始治疗的患者。应用多变量回归模型比较6个月的研究期间内SPC vs. FC应用的疗效。对国家级和州级结果进行分析和报告。采用药物持有率（MPR）衡量依从性，以停药率（终止治疗超过30天）评估持久性。医疗资源利用和花费包括住院和急诊就诊频率以及医疗成本相对基线的变化。 
    结果： 校正基线特征后，SPC患者（n = 382 476）的MPR显著高于FC患者（n = 197 375）（Δ= 11.6%；95% CI：11.4%~11.7%）较。SPC患者与FC患者相比，全因住院率（校正后发生率比值[IRR] = 0.77；95% CI：0.75~0.79）和ER就诊率（校正后IRR = 0.87；95% CI：0.86~0.89）较低。心血管相关医疗资源利用结果与全因医疗资源利用结果相似。与FC患者相比，在初始治疗后的全因医疗成本上，SPC患者显示出较大幅度的降低，为-＄208（95% CI：-＄302~-＄114），但在高血压相关处方成本上增加较大，增加了＄53（95% CI：＄51~＄55）。州级结果在用于比较依从性的数量级和比较方向上基本一致，成本上存在较大的区域差异。其局限性可能包括来自不可见因素的残留混杂。 
    结论：在国家级及几乎所有州的高血压患者中，与FC相比，SPC的依从性/持久性与较好，住院率及急诊就诊率较低。在大部分州中，应用SPC在医疗成本上的大幅降低远远抵消了较高的药物成本。

    OBJECTIVES: To compare compliance/persistence， health care resource utilization，  and costs associated with single-pill combination (SPC) vs. free-combination (FC) therapies among adult hypertension patients at the national and state level. Combination therapies with angiotensin receptor blocker (ARB) + calcium channel blocker， ARB + hydrochlorothiazide， and angiotensin-converting enzyme inhibitor + hydrochlorothiazide were evaluated.
    METHODS: Patients initiated on SPC or FC were identified in the MarketScan Database (2006-2008). Multivariate regression models were used to compare the health care outcomes of SPC vs. FC use during the 6-month study period. National- and state-level outcomes were analyzed and reported. Compliance was measured by medication possession ratio (MPR)， and persistence was assessed based on treatment discontinuation (i.e.， a lapse in therapy exceeding 30 days). Utilization and cost outcomes included frequencies of inpatient and emergency room (ER) visits and changes in health care costs from baseline.
    RESULTS: Adjusting for baseline characteristics， SPC patients (N = 382，476) demonstrated significantly higher MPR than FC patients (N = 197，375) (difference = 11.6%; 95% confidence interval [CI]: 11.4%， 11.7%). SPC patients had fewer all-cause hospitalizations (adjusted incidence rate ratio [IRR] = 0.77; 95% CI: 0.75， 0.79) and ER visits (adjusted IRR = 0.87; 95% CI: 0.86， 0.89) than  FC patients. Results for cardiovascular-related utilization were similar to all-cause results. Compared to FC， SPC patients showed significantly greater reductions post-therapy initiation in all-cause medical costs by -＄208 (95% CI: -＄302， -＄114)， but larger increases in hypertension-related prescription costs by ＄53 (95% CI: ＄51， ＄55). State-level results were generally consistent in magnitude and direction for comparisons of compliance and utilization， with greater regional variation in costs. Limitations include the possibility of residual confounding from factors not observable in claims.
    CONCLUSION: SPC use was associated with significantly better compliance/persistence and fewer hospitalizations and ER visits than FC in hypertensive patients at the national level and in almost all states. Larger reductions in medical costs with SPC use more than offset higher drug costs within most states.

Yang W， Chang J， Kahler KH， et.al