Bosmans Judith E, van der Laan Danielle M, Yang Yuanhang, Elders Petra J M, Boons Christel C L M, Nijpels Giel, Hugtenburg Jacqueline G
Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Front Pharmacol. 2019 Mar 7;10:210. doi: 10.3389/fphar.2019.00210. eCollection 2019.
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. 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. 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. 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.
高血压被视为一个重要的公共卫生问题。疾病管理不善和不坚持服用抗高血压药物可能导致临床效果欠佳，从而给社会带来经济负担。本研究评估了一项由药剂师主导的、针对患者量身定制的干预项目的成本效益，该项目旨在提高抗高血压药物的依从性，并与常规护理进行比较。在一项实用的随机对照试验中，对170名正在服用抗高血压药物的患者进行了为期9个月的随访，并同时进行了经济评估。效果指标包括自我报告的依从性（MARS-5）、对药物的信念（BMQ关注和必要性量表）以及质量调整生命年（QALYs）。成本是从社会角度进行衡量的。缺失的成本和效果数据采用多重填补法进行估算。使用自抽样法来估计成本差异和增量成本效益比周围的不确定性。估计了成本效益平面和可接受性曲线。干预项目与常规护理在成本或效果方面没有显著差异。在每获得一个单位效果的支付意愿值为0欧元时，干预措施相对于常规护理具有成本效益的概率为0.27。在每获得一个单位效果的支付意愿值为20,000欧元时，对于连续的MARS-5评分、二分法的MARS-5评分、BMQ关注量表、BMQ必要性量表和QALYs，具有成本效益的概率分别为0.70、0.27、0.64、0.87和0.36。在高血压患者中，就自我报告的药物依从性、对药物的信念和QALYs而言，与常规护理相比，由药剂师主导的、针对患者量身定制的提高药物依从性的干预项目不被认为具有成本效益。
