Cost Impact of Switching From Metoprolol to Nebivolol for Hypertension

Objective: To assess the economic impact of switching from metoprolol to nebivolol for hypertension treatment. Study Design: Retrospective analysis of a large single-payer administrative claims database (first quarter 2010-first quarter 2013). Methods: Adult patients with hypertension, who switched from metoprolol to nebivolol were identified. Patients were required to use each treatment for >= 30 days. Switching was defined as a <= 30-day gap or overlap between metoprolol discontinuation and nebivolol initiation. Patients who used other beta-blockers concomitantly with metoprolol or nebivolol, or had compelling indications for metoprolol (angina, myocardial infarction, or congestive heart failure), during the 180-day period before nebivolol initiation were excluded. Monthly all-cause and cardiovascular (CV)-related healthcare resource use (HRU), medical service costs (2013 US dollars), and medication costs were compared between the pre- and postswitching periods. Sensitivity analyses on treatment exposure were conducted. Results: Among the 1046 patients identified, the average age was 53 years and 46% were female. Following a switch to nebivolol, there was a significant (P < .01) decrease in all HRU. Monthly all-cause costs for prescription medications increased by $134 (P < .01); however, all-cause medical service costs decreased by $211 ($1485 vs $1274; P < .01). Total monthly all-cause healthcare costs (medical services and prescription medications) were similar before and after switching ($1780 vs $1702; P = .05). Similarly, monthly CV-related medication costs increased while medical costs decreased following the switch. HRU and cost trends were similar in the sensitivity analyses. Conclusions: Increases in prescription drug costs may be offset by decreases in medical costs among patients with hypertension who switched from metoprolol to nebivolol.