Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA USA.
Division of Workforce Development Centers for Disease Control and Prevention Atlanta GA USA.
J Am Heart Assoc. 2024 Nov 5;13(21):e037357. doi: 10.1161/JAHA.124.037357. Epub 2024 Nov 4.
Hypertension affects nearly half of US adults yet remains inadequately controlled in over three-quarters of these cases. This study aimed to assess the association between adherence to antihypertensive medications and total medical costs, health care use, and productivity-related outcomes.
We conducted cross-sectional analyses using MarketScan databases, which included individuals aged 18 to 64 years with noncapitated health insurance plans in 2019. Adherence was defined as ≥80% medication possession ratio for prescribed antihypertensive medications. We used a generalized linear model to estimate total medical costs, a negative binomial model to estimate health care use (emergency department visits and inpatient admissions), an exponential hurdle model to estimate productivity-related outcomes (number of sick absences, short-term disability, long-term disability), and a 2-part model to estimate productivity-related costs in 2019 US dollars. All models were adjusted for age, sex, urbanicity, census region, and comorbidities. We reported average marginal effects for outcomes related to antihypertensive medication adherence. Among 379 503 individuals with hypertension in 2019, 54.4% adhered to antihypertensives. Per person, antihypertensive medication adherence was associated with $1441 lower total medical costs, $11 lower sick absence costs, $291 lower short-term disability costs, and $69 lower long-term disability costs. Per 1000 individuals, medication adherence was associated with lower health care use, including 200 fewer emergency department visits and 90 fewer inpatient admissions, and productivity-related outcomes, including 20 fewer sick absence days and 442 fewer short-term disability days.
Adherence to antihypertensives was consistently associated with lower total medical costs, reduced health care use, and improved productivity-related outcomes.
高血压影响了近半数的美国成年人，但仍有超过四分之三的患者血压控制不理想。本研究旨在评估抗高血压药物治疗的依从性与总医疗费用、医疗保健使用和与生产力相关的结果之间的关联。
我们使用 MarketScan 数据库进行了横断面分析，该数据库包含了 2019 年年龄在 18 至 64 岁之间、参加无自付额健康保险计划的个体。依从性定义为处方抗高血压药物的用药比例≥80%。我们使用广义线性模型来估计总医疗费用，使用负二项式模型来估计医疗保健使用（急诊就诊和住院），使用指数障碍模型来估计与生产力相关的结果（病假天数、短期残疾、长期残疾），并使用 2 部分模型来估计 2019 年美元的与生产力相关的成本。所有模型均根据年龄、性别、城市状况、人口普查区域和合并症进行了调整。我们报告了与抗高血压药物治疗依从性相关的结果的平均边际效应。在 2019 年的 379503 名高血压患者中，有 54.4%的患者依从了抗高血压药物治疗。对于个人而言，抗高血压药物治疗的依从性与总医疗费用降低 1441 美元、病假费用降低 11 美元、短期残疾费用降低 291 美元和长期残疾费用降低 69 美元相关。每 1000 名患者，药物治疗的依从性与较低的医疗保健使用相关，包括急诊就诊减少 200 次，住院减少 90 次，以及与生产力相关的结果，包括病假减少 20 天和短期残疾减少 442 天。
抗高血压药物治疗的依从性与总医疗费用降低、医疗保健使用减少和与生产力相关的结果改善始终相关。
