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The cost and effectiveness of adherence-improving interventions for antihypertensive and lipid-lowering drugs*

R H Chapman1, C P Ferrufino, S L Kowal

  • 1US Health Economics and Outcomes Research, IMS Health, Falls Church, VA 22046, USA. RChapman@us.imshealth.com

International Journal of Clinical Practice
|January 22, 2010
PubMed

Insights

Improving adherence to cardiovascular medications requires cost-effective interventions. This review found that while more expensive interventions like case management are more effective, simpler methods like reminders are less costly, guiding future program design.

Area of Science:

  • Cardiovascular medicine
  • Health economics
  • Behavioral science

Background:

  • Poor adherence to cardiovascular medications is a significant public health issue.
  • Interventions to improve medication adherence are widely proposed but often lack comprehensive cost-effectiveness analysis.
  • Understanding the relationship between intervention costs and effectiveness is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To review the effectiveness and associated costs of various interventions designed to improve adherence to cardiovascular disease therapies.
  • To update previous reviews by incorporating recent studies on adherence interventions.
  • To provide data to guide the selection and implementation of cost-effective adherence programs.

Main Methods:

  • A systematic review of MEDLINE was conducted, updating a prior review with studies published between July 2002 and October 2007.
  • Eligible studies compared at least one intervention against a control group, used objective adherence measures, and followed patients for at least six months.
  • Effectiveness was quantified as relative improvement (RI), and costs were calculated and adjusted to 2007 US dollars for a six-month period.

Main Results:

  • The review identified 23 interventions from 18 studies, with relative improvements in adherence ranging from 1.11 to 4.65.
  • Six-month intervention costs varied significantly, from $10 to $142 per patient.
  • Reminder interventions were least effective (RI: 1.11-1.14) but most cost-effective ($10/6 months), while case management was most effective (RI: 1.23-4.65) but most expensive ($90-$130/6 months).

Conclusions:

  • A positive association generally exists between the cost of adherence interventions and their effectiveness.
  • The findings suggest that a balance between cost and effectiveness should guide the design and implementation of cardiovascular medication adherence programs.
  • Considering both the benefits to adherence and the associated costs is essential for developing successful interventions.
Abstract

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