The cost-effectiveness of an intervention program to enhance adherence to antihypertensive medication in comparison with usual care in community pharmacies

Judith E. Bosmans; Danielle M. Van Der Laan; Yuanhang Yang; Petra J.M. Elders; Giel Nijpels; Jacqueline G. Hugtenburg

doi:10.3389/fphar.2019.00210

The cost-effectiveness of an intervention program to enhance adherence to antihypertensive medication in comparison with usual care in community pharmacies

Judith E. Bosmans, Danielle M. Van Der Laan^*, Yuanhang Yang, Petra J.M. Elders, Giel Nijpels, Jacqueline G. Hugtenburg

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Introduction: Hypertension is considered an important public health issue. Inadequate disease management and non-adherence to antihypertensive medication may result in suboptimal clinical outcomes thereby imposing a financial burden on society. This study evaluates the cost-effectiveness of a patient-tailored, pharmacist-led intervention program aimed to enhance adherence to antihypertensive medication in comparison with usual care. Materials and Methods: An economic evaluation was conducted alongside a pragmatic randomized controlled trial with 9-months follow-up among 170 patients using antihypertensive medication. Effect outcomes included self-reported adherence (MARS-5), beliefs about medicines (BMQ Concern and Necessity scales) and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective. Missing cost and effect data were imputed using multiple imputation. Bootstrapping was used to estimate uncertainty around the cost-differences and the incremental cost-effectiveness ratios. Cost-effectiveness planes and acceptability curves were estimated. Results: There were no significant differences in costs or effects between the intervention program and usual care. The probability of cost-effectiveness of the intervention in comparison with usual care was 0.27 at a willingness-to-pay value of 0 €/unit of effect gained. At a willingness-to-pay value of 20,000 €/unit of effect gained, the probability of cost-effectiveness was 0.70, 0.27, 0.64, 0.87, and 0.36 for the continuous MARS-5 score, dichotomized MARS-5 score, BMQ Concern scale, BMQ Necessity scale and QALYs, respectively. Discussion: In patients with hypertension, the patient-tailored, pharmacist-led intervention program to enhance medication adherence was not considered cost-effective as compared to usual care with regard to self-reported medication adherence, beliefs about medicines and QALYs.

Original language	English
Article number	210
Journal	Frontiers in Pharmacology
Volume	10
Issue number	MAR
DOIs	https://doi.org/10.3389/fphar.2019.00210
Publication status	Published - 1 Jan 2019

Funding

This study was funded by the Royal Dutch Pharmacists Association (KNMP). The funding body did not have any role in trial design, collection, analysis, or interpretation of data, nor in writing the manuscript.

Funders	Funder number
KNMP
Royal Dutch Pharmacists Association

Keywords

Antihypertensive medication
Community pharmacies
Cost-effectiveness
Hypertension
Medication adherence
Patient-tailored intervention

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3389/fphar.2019.00210

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416217

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@article{b14dfd5ceffe4c74bbc6213f069d7bfb,

title = "The cost-effectiveness of an intervention program to enhance adherence to antihypertensive medication in comparison with usual care in community pharmacies",

abstract = "Introduction: Hypertension is considered an important public health issue. Inadequate disease management and non-adherence to antihypertensive medication may result in suboptimal clinical outcomes thereby imposing a financial burden on society. This study evaluates the cost-effectiveness of a patient-tailored, pharmacist-led intervention program aimed to enhance adherence to antihypertensive medication in comparison with usual care. Materials and Methods: An economic evaluation was conducted alongside a pragmatic randomized controlled trial with 9-months follow-up among 170 patients using antihypertensive medication. Effect outcomes included self-reported adherence (MARS-5), beliefs about medicines (BMQ Concern and Necessity scales) and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective. Missing cost and effect data were imputed using multiple imputation. Bootstrapping was used to estimate uncertainty around the cost-differences and the incremental cost-effectiveness ratios. Cost-effectiveness planes and acceptability curves were estimated. Results: There were no significant differences in costs or effects between the intervention program and usual care. The probability of cost-effectiveness of the intervention in comparison with usual care was 0.27 at a willingness-to-pay value of 0 €/unit of effect gained. At a willingness-to-pay value of 20,000 €/unit of effect gained, the probability of cost-effectiveness was 0.70, 0.27, 0.64, 0.87, and 0.36 for the continuous MARS-5 score, dichotomized MARS-5 score, BMQ Concern scale, BMQ Necessity scale and QALYs, respectively. Discussion: In patients with hypertension, the patient-tailored, pharmacist-led intervention program to enhance medication adherence was not considered cost-effective as compared to usual care with regard to self-reported medication adherence, beliefs about medicines and QALYs.",

keywords = "Antihypertensive medication, Community pharmacies, Cost-effectiveness, Hypertension, Medication adherence, Patient-tailored intervention",

author = "Bosmans, {Judith E.} and {Van Der Laan}, {Danielle M.} and Yuanhang Yang and Elders, {Petra J.M.} and Giel Nijpels and Hugtenburg, {Jacqueline G.}",

year = "2019",

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The cost-effectiveness of an intervention program to enhance adherence to antihypertensive medication in comparison with usual care in community pharmacies. / Bosmans, Judith E.; Van Der Laan, Danielle M.; Yang, Yuanhang et al.
In: Frontiers in Pharmacology, Vol. 10, No. MAR, 210, 01.01.2019.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - The cost-effectiveness of an intervention program to enhance adherence to antihypertensive medication in comparison with usual care in community pharmacies

AU - Bosmans, Judith E.

AU - Van Der Laan, Danielle M.

AU - Yang, Yuanhang

AU - Elders, Petra J.M.

AU - Nijpels, Giel

AU - Hugtenburg, Jacqueline G.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Hypertension is considered an important public health issue. Inadequate disease management and non-adherence to antihypertensive medication may result in suboptimal clinical outcomes thereby imposing a financial burden on society. This study evaluates the cost-effectiveness of a patient-tailored, pharmacist-led intervention program aimed to enhance adherence to antihypertensive medication in comparison with usual care. Materials and Methods: An economic evaluation was conducted alongside a pragmatic randomized controlled trial with 9-months follow-up among 170 patients using antihypertensive medication. Effect outcomes included self-reported adherence (MARS-5), beliefs about medicines (BMQ Concern and Necessity scales) and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective. Missing cost and effect data were imputed using multiple imputation. Bootstrapping was used to estimate uncertainty around the cost-differences and the incremental cost-effectiveness ratios. Cost-effectiveness planes and acceptability curves were estimated. Results: There were no significant differences in costs or effects between the intervention program and usual care. The probability of cost-effectiveness of the intervention in comparison with usual care was 0.27 at a willingness-to-pay value of 0 €/unit of effect gained. At a willingness-to-pay value of 20,000 €/unit of effect gained, the probability of cost-effectiveness was 0.70, 0.27, 0.64, 0.87, and 0.36 for the continuous MARS-5 score, dichotomized MARS-5 score, BMQ Concern scale, BMQ Necessity scale and QALYs, respectively. Discussion: In patients with hypertension, the patient-tailored, pharmacist-led intervention program to enhance medication adherence was not considered cost-effective as compared to usual care with regard to self-reported medication adherence, beliefs about medicines and QALYs.

AB - Introduction: Hypertension is considered an important public health issue. Inadequate disease management and non-adherence to antihypertensive medication may result in suboptimal clinical outcomes thereby imposing a financial burden on society. This study evaluates the cost-effectiveness of a patient-tailored, pharmacist-led intervention program aimed to enhance adherence to antihypertensive medication in comparison with usual care. Materials and Methods: An economic evaluation was conducted alongside a pragmatic randomized controlled trial with 9-months follow-up among 170 patients using antihypertensive medication. Effect outcomes included self-reported adherence (MARS-5), beliefs about medicines (BMQ Concern and Necessity scales) and quality-adjusted life-years (QALYs). Costs were measured from a societal perspective. Missing cost and effect data were imputed using multiple imputation. Bootstrapping was used to estimate uncertainty around the cost-differences and the incremental cost-effectiveness ratios. Cost-effectiveness planes and acceptability curves were estimated. Results: There were no significant differences in costs or effects between the intervention program and usual care. The probability of cost-effectiveness of the intervention in comparison with usual care was 0.27 at a willingness-to-pay value of 0 €/unit of effect gained. At a willingness-to-pay value of 20,000 €/unit of effect gained, the probability of cost-effectiveness was 0.70, 0.27, 0.64, 0.87, and 0.36 for the continuous MARS-5 score, dichotomized MARS-5 score, BMQ Concern scale, BMQ Necessity scale and QALYs, respectively. Discussion: In patients with hypertension, the patient-tailored, pharmacist-led intervention program to enhance medication adherence was not considered cost-effective as compared to usual care with regard to self-reported medication adherence, beliefs about medicines and QALYs.

KW - Antihypertensive medication

KW - Community pharmacies

KW - Cost-effectiveness

KW - Hypertension

KW - Medication adherence

KW - Patient-tailored intervention

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DO - 10.3389/fphar.2019.00210

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SN - 1663-9812

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JO - Frontiers in Pharmacology

JF - Frontiers in Pharmacology

IS - MAR

M1 - 210

ER -

The cost-effectiveness of an intervention program to enhance adherence to antihypertensive medication in comparison with usual care in community pharmacies

Abstract

Funding

Keywords

UN SDGs

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