Department of Pharmacotherapy College of Pharmacy, University of Utah Salt Lake City UT USA.
Matheson Center for Health Care Studies University of Utah Salt Lake City UT USA.
J Am Heart Assoc. 2024 Nov 19;13(22):e037792. doi: 10.1161/JAHA.124.037792. Epub 2024 Nov 15.
Poor adherence to chronic cardiovascular treatments can impede targeted clinical outcomes. This study estimates the potential benefits of improving adherence among patients with cardiovascular disease requiring secondary prevention in Mexico, Thailand, and China.
We performed Markov model simulation for patients with cardiovascular disease in 3 countries from health care and societal perspectives over a lifetime horizon. Two scenarios were compared: (1) optimal adherence based on a meta-analysis of 51 randomized controlled trials and (2) status quo. The association between adherence and cardiovascular disease outcomes derives from a dose-response meta-analysis of 4 051 338 patients. Outcomes include the accumulated number of cardiovascular events and associated costs in 2022 US dollars, life years, and quality-adjusted life years. Optimal adherence could prevent 42 (95% credible interval [CrI], 29-56) cardiovascular events in Mexico, 34 (95% CrI, 24-50) in Thailand, and 63 (95% CrI, 43-89) in China per 1000 patients over a lifetime. Incremental effectiveness per patient was 0.60 (95% CrI, 0.47-0.74) life-years in Mexico, 0.68 (95% CrI, 0.37-0.94) quality-adjusted life years in Thailand, and 0.93 (95% CrI, 0.44-1.27) quality-adjusted life years in China. Cost savings from societal perspective amounted to $412 (95% CrI, $211-$723), $316 (95% CrI, $187-$541), and $700 (95% CrI, $355-$1144) per patient for Mexico, Thailand, and China, respectively. Findings remained cost saving in deterministic and probabilistic sensitivity analyses.
Achieving optimal adherence in patients with cardiovascular disease requiring lipid-lowering therapy saves costs and improves health outcomes in Mexico, Thailand, and China. These findings support national health care systems implementing strategies to improve adherence in these countries.
慢性心血管治疗的依从性差可能会阻碍靶向临床结局。本研究旨在评估改善墨西哥、泰国和中国需要二级预防的心血管疾病患者的依从性的潜在获益。
我们从医疗保健和社会角度，对 3 个国家的心血管疾病患者进行了马尔可夫模型模拟，时间范围为终身。比较了两种情况：（1）基于对 51 项随机对照试验的荟萃分析的最佳依从性，（2）现状。依从性与心血管疾病结局的关系来自于对 4051338 例患者的剂量-反应荟萃分析。结果包括 2022 年以美元计算的心血管事件累积数量和相关成本、生命年和质量调整生命年。在墨西哥，最佳依从性可预防每 1000 例患者 42 例（95%可信区间[CrI]，29-56）心血管事件，泰国 34 例（95% CrI，24-50），中国 63 例（95% CrI，43-89）。每位患者的增量有效性为墨西哥 0.60（95% CrI，0.47-0.74）个生命年，泰国 0.68（95% CrI，0.37-0.94）个质量调整生命年，中国 0.93（95% CrI，0.44-1.27）个质量调整生命年。从社会角度来看，成本节约分别为墨西哥 412 美元（95% CrI，211-723）、泰国 316 美元（95% CrI，187-541）和中国 700 美元（95% CrI，355-1144）。在确定性和概率敏感性分析中，结果仍然是节省成本的。
在需要降脂治疗的心血管疾病患者中实现最佳依从性可节省成本并改善墨西哥、泰国和中国的健康结局。这些发现支持国家卫生保健系统在这些国家实施改善依从性的策略。
