Armstrong Shannon O, Little Richard A
The Medicines Company, Health Economics and Outcomes Research , Parsippany, NJ, USA.
Consultant Health Economist, Cambridge, UK.
Patient Prefer Adherence. 2019 Aug 15;13:1375-1389. doi: 10.2147/PPA.S213258. eCollection 2019.
Cardiovascular disease (CVD) is the leading cause of death in the United States, and high cholesterol is a leading risk factor for CVD. While statins are effective at reducing cholesterol, they are frequently underused in patients at highest risk of CVD. The objective of this study was to identify interventions which may improve adherence to statins and to assess their cost effectiveness within the US Medicare population.
A literature review was undertaken to identify interventions to improve adherence in patients with CVD at highest risk of a recurrent event and to quantify non-adherence and the consequences of non-adherence to statins in this population. A Markov cost-utility model was developed to assess the cost effectiveness of these interventions.
Ten adherence interventions were identified in the literature, with 6 demonstrating statistically significant improvement in adherence. The six interventions were disease management, interactive voice response, nurse counselling, discharge letter, nurse/dietician counselling and electronic pill bottle with feedback. The model found the cost effectiveness of an intervention was highly dependent on its effectiveness and costs. Incremental cost effectiveness ratios ranged from $27,545/QALY for discharge letter with large adherence gain to $130,399/QALY for disease management program with small adherence gain.
Some interventions to improve adherence have been shown to be effective, but little attention has been paid to the costs. Further studies on adherence interventions should include economic evaluations.
心血管疾病（CVD）是美国的主要死因，高胆固醇是心血管疾病的主要危险因素。虽然他汀类药物在降低胆固醇方面有效，但在心血管疾病风险最高的患者中，它们的使用常常不足。本研究的目的是确定可能提高他汀类药物依从性的干预措施，并评估其在美国医疗保险人群中的成本效益。
进行文献综述，以确定改善复发性事件风险最高的心血管疾病患者依从性的干预措施，并量化该人群中不依从他汀类药物的情况及其后果。开发了一个马尔可夫成本效用模型来评估这些干预措施的成本效益。
文献中确定了10种依从性干预措施，其中6种显示出依从性有统计学意义的改善。这六种干预措施是疾病管理、交互式语音应答、护士咨询、出院信、护士/营养师咨询和带反馈的电子药瓶。该模型发现，一种干预措施的成本效益高度依赖于其有效性和成本。增量成本效益比范围从依从性大幅提高的出院信的每质量调整生命年27,545美元到依从性小幅提高的疾病管理计划的每质量调整生命年130,399美元。
一些提高依从性的干预措施已被证明是有效的，但对成本的关注很少。关于依从性干预措施的进一步研究应包括经济评估。
