title: Association of Antihypertensive Medication Adherence With Healthcare Use and Medicaid Expenditures for Acute Cardiovascular Events.
abstract: OBJECTIVE
  We assessed the impact of antihypertensive medication (AHM) adherence on the incidence and associated Medicaid costs of acute cardiovascular disease (CVD) events among Medicaid beneficiaries.
  
  
  METHODS
  The study cohort (n=59,037) consists of nonelderly adults continuously enrolled (36 mo and above) in a Medicaid fee-for-service program. AHM adherence was calculated using the medication possession ratio (MPR) and stratified to low (MPR<60%), moderate (60%≤MPR<80%), and high (MPR≥80%) levels. We used a proportional hazard model to estimate risk for acute CVD events and generalized linear models to estimate Medicaid per-patient-per-year costs.
  
  
  RESULTS
  Low and moderate adherence subgroups had about 1.8 and 1.4 times higher risk of acute CVD events, compared with high adherence subgroup. By adherence level, Medicaid per-patient per-year costs for (1) CVD-related emergency department visits and hospitalizations were $661 (low), $479 (moderate), and $343 (high) and (2) AHMs were $430 (low), $604 (moderate), and $664 (high). Costs for CVD events and AHMs combined were similar across adherence subgroups.
  
  
  CONCLUSIONS
  Lower adherence to AHM was associated with progressively higher CVD risk. The increase in medication cost from higher AHM adherence was offset solely by reduced Medicaid spending on acute CVD events.
authors.affiliation: *Policy Research Analysis and Development Office, Office of the Associate Director for Policy, Centers for Disease Control and Prevention†Department of Health Policy and Management, Rollins School of Public Health, Emory University‡National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Division of Heart Disease and Stroke Prevention, Atlanta, GA.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Yang
authors.forename: David H
authors.initials: DH
authors.lastname: Howard
authors.forename: Julie
authors.initials: J
authors.lastname: Will
authors.forename: Fleetwood
authors.initials: F
authors.lastname: Loustalot
authors.forename: Matthew
authors.initials: M
authors.lastname: Ritchey
authors.forename: Kakoli
authors.initials: K
authors.lastname: Roy
mesh_terms: D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents