The Modeled Lifetime Cost-Effectiveness of Published Adherence-Improving Interventions for Antihypertensive and Lipid-Lowering Medications
| Autor: | Linda Chen, S. Kowal, Spencer B. Cherry, Cheryl P Ferrufino, Richard H. Chapman, Craig S. Roberts |
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| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
literature review Cost effectiveness Cost-Benefit Analysis Population Pharmacist MEDLINE Psychological intervention Alternative medicine Hyperlipidemias improving adherence adherence intervention Medication Adherence lipid-lowering cardiovascular disease Intervention (counseling) Humans Medicine antihypertensive education Intensive care medicine cost-effectiveness Antihypertensive Agents health care economics and organizations Hypolipidemic Agents education.field_of_study Cost–benefit analysis business.industry Health Policy Public Health Environmental and Occupational Health Models Economic Hypertension Physical therapy business |
| Zdroj: | Value in Health. 13(6):685-694 |
| ISSN: | 1098-3015 |
| DOI: | 10.1111/j.1524-4733.2010.00774.x |
| Popis: | Objective We sought to compare the cost-effectiveness of different interventions that have been shown to improve adherence with antihypertensive and lipid-lowering therapy, by combining a burden of nonadherence model framework with literature-based data on adherence-improving interventions. Methods MEDLINE was reviewed for studies that evaluated ≥1 adherence intervention compared with a control, used an adherence measure other than self-report, and followed patients for ≥6 months. Effectiveness was assessed as Relative Improvement, ratio of adherence with an intervention versus control. Costs, standardized to 12 months and adjusted to 2007 US$, and effectiveness estimates for each intervention were entered into a previously published model designed to measure the burden of nonadherence with antihypertensive and lipid-lowering medications, in a hypertensive population. Outputs included direct medical costs and incremental costs per quality-adjusted life-year (QALY) gained. Results After screening, 23 eligible adherence-improving interventions were identified from 18 studies. Relative Improvement ranged from 1.13 to 3.60. After eliminating more costly/less effective interventions, two remained. Self-monitoring, reminders, and educational materials incurred total health-care costs of $17,520, and compared with no adherence intervention, had an incremental cost-effectiveness ratio (ICER) of $4984 per QALY gained. Pharmacist/nurse management incurred total health-care costs of $17,896, and versus self-monitoring, reminders, and education had an ICER of $6358 per QALY gained. Conclusions Of published interventions shown to improve adherence, reminders and educational materials, and a pharmacist/nurse management program, appear to be cost-effective and should be considered before other interventions. Understanding relative cost-effectiveness of adherence interventions may guide design and implementation of efficient adherence-improving programs |
| Databáze: | OpenAIRE |
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