US Health Economics and Outcomes Research, IMS Health, Falls Church, VA 22046, USA.
Int J Clin Pract. 2010 Jan;64(2):169-81. doi: 10.1111/j.1742-1241.2009.02196.x.
Adherence to cardiovascular medications is poor. Accordingly, interventions have been proposed to improve adherence. However, as intervention-associated costs are rarely considered in full, we sought to review the effectiveness and costs associated with different adherence-improving interventions for cardiovascular disease therapies.
We reviewed MEDLINE to update a prior review of interventions to improve adherence with antihypertensive and/or lipid-lowering therapy covering January 1972 to June 2002, to add studies published from July 2002 to October 2007. Eligible studies evaluated > or = 1 intervention compared with a control, used measures other than self-report, reported significant improvement in adherence and followed patients for > or = 6 months. Effectiveness was measured as relative improvement (RI), the ratio of adherence in the intervention group to the control group. Costs were calculated based on those reported in the analysis, if available or estimated based on resource use described. All costs were truncated to 6 months and adjusted to 2007 US$.
Of 755 new articles, five met all eligibility criteria. Combining with the prior review gave 23 interventions from 18 studies. RI in adherence ranged from 1.11 to 4.65. Six-month intervention costs ranged from $10 to $142 per patient. Reminders had the lowest effectiveness (RI: 1.11-1.14), but were least costly ($10/6 months). Case management was most effective (RI: 1.23-4.65), but the most costly ($90-$130/6 months).
Generally, we found a positive association between intervention costs and effectiveness. Therefore, consideration of intervention costs, along with the benefits afforded to adherence, may help guide the design and implementation of adherence-improving programs.
心血管药物的依从性很差。因此，已经提出了一些干预措施来提高依从性。然而，由于很少全面考虑与干预相关的成本，我们试图回顾不同改善心血管疾病治疗药物依从性的干预措施的有效性和成本。
我们检索了 MEDLINE，以更新一项关于提高抗高血压和/或降脂治疗依从性的干预措施的综述，该综述涵盖了 1972 年 1 月至 2002 年 6 月，以增加 2002 年 7 月至 2007 年 10 月发表的研究。合格的研究评估了 > 或 = 1 种干预措施与对照组进行比较，使用了自我报告以外的其他措施，报告了依从性的显著改善，并对患者进行了 > 或 = 6 个月的随访。有效性以相对改善（RI）来衡量，即干预组的依从率与对照组的比值。如果分析中报告了成本，则根据报告的成本进行计算，或者根据描述的资源使用情况进行估算。所有成本都截断为 6 个月，并调整为 2007 年的美元。
在 755 篇新文章中，有 5 篇符合所有入选标准。将这些新文章与之前的综述结合起来，共纳入了 18 项研究中的 23 项干预措施。依从性的 RI 范围为 1.11 至 4.65。6 个月的干预成本为每位患者 10 至 142 美元。提醒的效果最低（RI：1.11-1.14），但成本最低（10 美元/6 个月）。病例管理最有效（RI：1.23-4.65），但成本最高（90-130 美元/6 个月）。
一般来说，我们发现干预成本与效果之间存在正相关关系。因此，考虑干预成本以及对依从性的益处可能有助于指导改善依从性的方案的设计和实施。
