title: Cost-effectiveness of enhancing adherence to therapy with blood pressure-lowering drugs in the setting of primary cardiovascular prevention.
abstract: 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.
authors.affiliation: Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Scotti
authors.forename: Gianluca
authors.initials: G
authors.lastname: Baio
authors.forename: Luca
authors.initials: L
authors.lastname: Merlino
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cesana
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000191:economics* / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D003327:Coronary Disease / Q000191:economics* / Q000209:etiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D018803:Models, Economic; D011322:Primary Prevention / Q000191:economics* / Q000379:methods; D016016:Proportional Hazards Models; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents