title: Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review.
abstract: BACKGROUND
  Hypertension and hyperlipidemia are major cardiovascular disease risk factors. To modify them, patients often need to adopt healthier lifestyles and adhere to prescribed medications. However, patients' adherence to recommended treatments has been suboptimal. Reducing out-of-pocket costs (ROPC) to patients may improve medication adherence and consequently improve health outcomes. This Community Guide systematic review examined the effectiveness of ROPC for medications prescribed for patients with hypertension and hyperlipidemia.
  
  
  METHODS
  We assessed effectiveness and economics of ROPC for medications to treat hypertension, hyperlipidemia, or both. Per Community Guide review methods, reviewers identified, evaluated, and summarized available evidence published from January 1980 through July 2015.
  
  
  RESULTS
  Eighteen studies were included in the analysis. ROPC interventions resulted in increased medication adherence for patients taking blood pressure and cholesterol medications by a median of 3.0 percentage points; proportion achieving 80% adherence to medication increased by 5.1 percentage points. Blood pressure and cholesterol outcomes also improved. Nine studies were included in the economic review, with a median intervention cost of $172 per person per year and a median change in health care cost of -$127 per person per year.
  
  
  CONCLUSIONS
  ROPC for medications to treat hypertension and hyperlipidemia is effective in increasing medication adherence, and, thus, improving blood pressure and cholesterol outcomes. Most ROPC interventions are implemented in combination with evidence-based health care interventions such as team-based care with medication counseling. An overall conclusion about the economics of the intervention could not be reached with the small body of inconsistent cost-benefit evidence.
authors.affiliation: Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop E-69, Atlanta, GA 30329. Email:gnjie@cdc.gov.
authors.forename: Gibril J
authors.initials: GJ
authors.lastname: Njie
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Ramona K C
authors.initials: RK
authors.lastname: Finnie
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sushama D
authors.initials: SD
authors.lastname: Acharya
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Verughese
authors.initials: V
authors.lastname: Jacob
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Krista K
authors.initials: KK
authors.lastname: Proia
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: David P
authors.initials: DP
authors.lastname: Hopkins
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
authors.forename: Nicolaas P
authors.initials: NP
authors.lastname: Pronk
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ron Z
authors.initials: RZ
authors.lastname: Goetzel
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, Minnesota.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kottke
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Rask
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.affiliation: Rush University, Chicago, Illinois.
authors.forename: Lynne T
authors.initials: LT
authors.lastname: Braun
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002784:Cholesterol / Q000097:blood; D003362:Cost-Benefit Analysis; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D006949:Hyperlipidemias / Q000191:economics* / Q000517:prevention & control; D006973:Hypertension / Q000191:economics* / Q000517:prevention & control; D012111:Residence Characteristics; D016903:Drug Monitoring
chemical_list: D002784:Cholesterol