title: The modeled lifetime cost-effectiveness of published adherence-improving interventions for antihypertensive and lipid-lowering medications.
abstract: 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.
authors.affiliation: US Health Economics and Outcomes Research, IMS Health, Falls Church, VA 22046, USA. rchapman@us.imshealth.com
authors.forename: Richard H
authors.initials: RH
authors.lastname: Chapman
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Kowal
authors.forename: Spencer B
authors.initials: SB
authors.lastname: Cherry
authors.forename: Cheryl P
authors.initials: CP
authors.lastname: Ferrufino
authors.forename: Craig S
authors.initials: CS
authors.lastname: Roberts
authors.forename: Linda
authors.initials: L
authors.lastname: Chen
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy / Q000191:economics; D006973:Hypertension / Q000188:drug therapy / Q000191:economics; D000960:Hypolipidemic Agents / Q000008:administration & dosage* / Q000191:economics*; D055118:Medication Adherence; D018803:Models, Economic
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents