Cost-Effectiveness of Enhancing Adherence to Therapy with Blood Pressure-Lowering Drugs in the Setting of Primary Cardiovascular Prevention

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• 作者：Lorenza Scotti ; PhD¹ ; Gianluca Baio ; PhD¹ ; Luca Merlino ; MD² ; Giancarlo Cesana ; MD³ ; Giuseppe Mancia ; MD³ ; ⁴ ; Giovanni Corrao ; PhD¹ ; ^{giovanni.corrao@unimib.it}
• 关键词：adherence ; administrative database ; blood pressure&ndash ; lowering drugs ; cardiovascular events ; cost-effectiveness
• 刊名：Value in Health
• 出版年：2013
• 出版时间：March-April, 2013
• 年：2013
• 卷：16
• 期：2
• 页码：318-324
• 全文大小：523 K

文摘

Objective

To estimate the cost-effectiveness of enhancing adherence to blood pressure (BP)-lowering drug therapy in a large population without signs of preexisting cardiovascular (CV) disease.

Methods

A cohort of 209,650 patients aged 40 to 79 years resident in the Italian Region of Lombardia and newly treated with BP-lowering drugs during 2000 to 2001 was followed from index prescription to 2007. During the follow-up, the 10,688 patients who experienced a hospitalization for a coronary or cerebrovascular event were identified (outcome). Adherence was measured by the proportion of days covered by the therapy with BP-lowering drugs. The cost-effectiveness of enhancing adherence was measured through the incremental cost-effectiveness ratio.

Results

Enhancing adherence from 52 % (baseline) to 60 % and 80 % led to a reduced rate for CV outcomes (from 85 to 83 and 77 events every 10,000 person-year, respectively) and increased the cost for drug therapy (from €1,325k to €1,507k and €1,934k every 10,000 person-year, respectively). The resulting incremental cost-effectiveness ratio decreased from €76k (95 % confidence interval €74k-€77k) to €74k (95 % confidence interval €72k-€75k) for each CV event avoided by enhancing adherence from baseline to 60 % and 80 % , respectively.

Conclusions

Enhancing adherence to BP-lowering medications in the setting of primary CV prevention might offer important benefits in reducing the risk of CV outcome, but at a substantial cost.