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The European Journal of Health Economics

, Volume 16, Issue 1, pp 65–72 | Cite as

Cost of poor adherence to anti-hypertensive therapy in five European countries

  • F. S. Mennini
  • A. MarcellusiEmail author
  • J. M. Graf von der Schulenburg
  • A. Gray
  • P. Levy
  • P. Sciattella
  • M. Soro
  • G. Staffiero
  • J. Zeidler
  • A. Maggioni
  • R. E. Schmieder
Original Paper

Abstract

The financial burden for EU health systems associated with cardiovascular disease (CV) has been estimated to be nearly €110 billion in 2006, corresponding to 10 % of total healthcare expenditure across EU or a mean €223 annual cost per capita. The main purpose of this study is to estimate the costs related to hypertension and the economic impact of increasing adherence to anti-hypertensive therapy in five European countries (Italy, Germany, France, Spain and England). A probabilistic prevalence-based decision tree model was developed to estimate the direct costs of CV related to hypertension (CV defined as: stroke, heart attack, heart failure) in five European countries. Our model considered adherence to hypertension treatment as a main driver of blood pressure (BP) control (BP < 140/90 mmHg). Relative risk of CV, based on controlled or uncontrolled BP group, was estimated from the Framingham Heart Study and national review data. Prevalence and cost data were estimated from national literature reviews. A national payer (NP) perspective for 10 years was considered. Probabilistic sensitivity analysis was performed in order to evaluate uncertainty around the results (given as 95 % confidence intervals). The model estimated a total of 8.6 million (1.4 in Italy, 3.3 in Germany, 1.2 in Spain, 1.8 in France and 0.9 in England) CV events related to hypertension over the 10-year time horizon. Increasing the adherence rate to anti-hypertensive therapy to 70 % (baseline value is different for each country) would lead to 82,235 fewer CV events (24,058 in Italy, 7,870 in Germany, 18,870 in Spain, 24,855 in France and 6,553 in England). From the NP perspective, the direct cost associated with hypertension was estimated to be €51.3 billion (8.1 in Italy, 17.1 in Germany, 12.2 in Spain, 8.8 in France and 5.0 in England). Increasing adherence to anti-hypertensive therapy to 70 % would save a total of €332 million (CI 95 %: €319–346 million) from the NPs perspective. This study is the first attempt to estimate the economic impact of non-adherence amongst patients with diagnosed hypertension in Europe, using data from five European countries (Italy, France, Germany, Spain and England).

Keywords

Economic burden Hypertension Hypertensive therapy Cost of illness Adherence 

JEL Classification

H00 General public health 

Notes

Acknowledgment

The study was supported with unrestricted funding from Daiichi Sankyo Europe.

Supplementary material

10198_2013_554_MOESM1_ESM.docx (65 kb)
Supplementary material 1 (DOCX 65 kb)
10198_2013_554_MOESM2_ESM.pdf (1 mb)
Supplementary material 2 (PDF 1052 kb)

References

  1. 1.
    European Innovation partnership on active and healthy aging. Action group 1. https://webgate.ec.europa.eu/eipaha/actiongroup/index/a1
  2. 2.
    WHO global health observatory data repository (2013). http://apps.who.int/gho/data/node.main.887. Accessed Feb 2013
  3. 3.
    Leal, J., Luengo-Fernández, R., Gray, A., Petersen, S., Rayner, M.: Economic burden of cardiovascular diseases in the enlarged European Union. Eur. Heart J. 27(13), 1610–1619 (2006). Epub 2006 Feb 22PubMedCrossRefGoogle Scholar
  4. 4.
    Ong, K.L., Cheung, B.M., Man, Y.B., Lau, C.P., Lam, K.S.: Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension 49(1), 69–75 (2007). [PubMed:17159087]PubMedCrossRefGoogle Scholar
  5. 5.
    Krousel-Wood, M.A., Muntner, P., He, J., Whelton, P.K.: Primary prevention of essential hypertension. Med. Clin. North Am. 88, 223–238 (2004). [PubMed: 14871061]PubMedCrossRefGoogle Scholar
  6. 6.
    The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure.The JNC 7 report. JAMA 2003/289 2560–2572 [PubMed:12748199]Google Scholar
  7. 7.
    Morisky, D.E., Ang, A., Krousel-Wood, M., Ward, H.J.: Predictive validity of a medication adherence measure in an outpatient setting. J. Clin. Hypertens. (Greenwich) 10(5), 348–354 (2008)CrossRefGoogle Scholar
  8. 8.
    DiMatteo, M.R., Giordani, P.J., Lepper, H.S., Croghan, T.W.: Patient adherence and medical treatment outcomes: a meta-analysis. Discov. Med. 40, 794–811 (2002). [PubMed: 12218770]Google Scholar
  9. 9.
    Monane, M., Bohn, R.L., Gurwitz, J.H., Glynn, R.J., Levin, R., Avorn, J.: The effects of initial drug choice and comorbidity on antihypertensive therapy compliance. Results from a population-based study in the elderly. AJH 10, 697–704 (1997)PubMedGoogle Scholar
  10. 10.
    Degli Esposti, L., Saragoni, S., Benemei, S., Batacchi, P., Geppetti, P., Di Bari, M., Marchionni, N., Sturani, A., Buda, S., Degli Esposti, E.: Adherence to anti-hypertensive medications and health outcomes among newly treated hypertensive patients. Clinicoecon. Outcomes Res. 3, 47–54 (2011). doi: 10.2147/CEOR.S15619. (Epub 2011 Mar 7)PubMedCrossRefGoogle Scholar
  11. 11.
    DiMatteo, M.R.: Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med. Care 42(3), 200–209 (2004). (Assuming normal distribution)PubMedCrossRefGoogle Scholar
  12. 12.
    Girerd, X., Radauceanu, A., et al.: Evaluation de l’observance par l’interrogatoire au cours du suivi des hypertendus dans des consultations spécialisées. Arch. Mal. Coeur Vaiss. 94(8), 839–842 (2001)PubMedGoogle Scholar
  13. 13.
    Breitscheidel, L., Ehlken, B., Kostev, K., Oberdiek, A., Sandberg, A., Schmieder, R.E.: Real-life treatment patterns, compliance, persistence, and medication costs in patients with hypertension in Germany. J. Med. Econ. 15(1), 155–165 (2012)PubMedCrossRefGoogle Scholar
  14. 14.
    Clarke, P., Gray, A., Legood, R., Briggs, A., Holman, R.: The impact of diabetes-related complications on healthcare costs: results from the United Kingdom prospective diabetes study (UKPDS 65). Diabet. Med. 20(6), 442–450 (2003)PubMedCrossRefGoogle Scholar
  15. 15.
    Koçkaya, G., Wertheimer, A.: Can we reduce the cost of illness with more compliant patients? An estimation of the effect of 100% compliance with hypertension treatment. J. Pharm. Pract. 24(3), 345–350 (2011). doi: 10.1177/0897190010389336. (Epub 2010 Feb 20)PubMedCrossRefGoogle Scholar
  16. 16.
    Cramer, J.A., Roy, A., Burrell, A., Fairchild, C.J., Fuldeore, M.J., Ollendorf, D.A., Wong, P.K.: Medication compliance and persistence: terminology and definitions. Value Health 11(1), 44–47 (2008). doi: 10.1111/j.1524-4733.2007.00213.x PubMedCrossRefGoogle Scholar
  17. 17.
    D’Agostino Sr, R.B., Vasan, R.S., Pencina, M.J., Wolf, P.A., Cobain, M., Massaro, J.M., Kannel, W.B.: General cardiovascular risk profile for use in primary care: the framingham heart study. Circulation 117(6), 743–753 (2008). doi: 10.1161/CIRCULATIONAHA.107.699579. Epub 2008 Jan 22PubMedCrossRefGoogle Scholar
  18. 18.
    ISTAT Resident population by age, sex and marital status as at 1 January 2012 (2013). http://demo.istat.it/pop2011/index.html. Accessed Feb 2013
  19. 19.
  20. 20.
    Population census (2011) INE www.ine.es
  21. 21.
    Insee, estimations de population (2012) (résultats provisoires arrêtés à fin 2012)Google Scholar
  22. 22.
    Office for National Statistics, Mid-2010 Population Estimates: England; estimated resident population by single year of age and sex; revised in light of the 2011 censusGoogle Scholar
  23. 23.
    Osservatorio Epidemiologico Cardiovascolare: Atlante italiano delle malattie cardiovascolari—seconda edizione 2004 Ital. Heart J. (2nd ed) 5(3):1S–101SGoogle Scholar
  24. 24.
    Prugger, C., Heuschmann, P.U., Keil, U.: Epidemiologie der Hypertonie in Deutschlandundweltweit. Herz 31, 287–293 (2006)PubMedCrossRefGoogle Scholar
  25. 25.
    Banegas, J.R., et al.: Hipertensión arterial y política de salud en España”, MedicinaClinica, 132 (6): 222–229. Banegas JR, Graciani A, de la Cruz-Troca JJ, León-Muñoz LM, Guallar-Castillón P, Coca A, Ruilope LM, Rodríguez-Artalejo F. (2012): “Achievement of Cardiometabolic Goals in Aware Hypertensive Patients in Spain: a Nationwide Population-Based Study. Hypertension 60(4), 898–905 (2012)PubMedCrossRefGoogle Scholar
  26. 26.
    Banegas, J.R., Graciani, A., de la Cruz-Troca, J.J., León-Muñoz, L.M., Guallar-Castillón, P., Coca, A., Ruilope, L.M., Rodríguez-Artalejo, F.: Achievement of cardiometabolic goals in aware hypertensive patients in Spain: a nationwide population-based study. Hypertension 60(4), 898–905 (2012)PubMedCrossRefGoogle Scholar
  27. 27.
    Godet-Thobie H., Vernay M. et al. Niveau tensionnel moyen t prévalence de l’hypertension chez les adultes de 18 à 74 ans, ENNS 2006-2007. Bulletin Epidémiologique Hebdomadaire. N°49-50, (2008)Google Scholar
  28. 28.
    Health Survey for England 2011. Volume 1, chapter 3: Hypertension. The Health and Social care Information Centre, London.Google Scholar
  29. 29.
    Wagner A., Arveiler D. et al. Etat des lieux sur l’hypertension artérielle en France en 2007: l’étude Mona Lisa. Bulletin Epidémiologique Hebdomadaire. No.49-50, (2008)Google Scholar
  30. 30.
    HigherHealth Institute. RapportonazionalePassi 2009: rischiocardiovascolare. http://www.epicentro.iss.it/passi/cardiovascolare09.asp. Accessed Feb 2013
  31. 31.
    Gandjour, A., Lauterbach, K.W.: Wann lohnt es, eine medizinische Überversorgung abzubauen? Das Beispiel der VerschreibungteurerAntihypertonika. MedizinischeKlinik 100, 535–541 (2005)Google Scholar
  32. 32.
    Hypertension prevalence from Health Survey for England 2011. Volume 1, chapter 3: Hypertension. The Health and Social care Information Centre, London. Diagnosed numbers from NHS Information Centre, Quality and Outcomes Framework (QOF) for April 2011–March 2012, England; 2010–2011 dataGoogle Scholar
  33. 33.
    Italian Pharmaceutical Agency (AIFA). OSMED report 2011. http://www.agenziafarmaco.gov.it/it/content/rapporti-osmed-luso-dei-farmaci-italia. Accessed May 2013
  34. 34.
    Laux, G., Szecsenyi, J., Miksch, A., Grün, B., Gutscher, A., Rosemann, T., Kühlein, T.: Antihypertensive medikamentöse Therapie von gesetzlich und privat versicherten Patienten in der Primärversorgung. MedizinischeKlinik 104, 108–113 (2009)Google Scholar
  35. 35.
    Sicras-Mainar A., Navarro-Artieda R. updated from 2007 data into 2011 values with PCI data from the INE (2009)Google Scholar
  36. 36.
  37. 37.
    NICE clinical guideline CG127 Hypertension: costing template: http://guidance.nice.org.uk/CG127/CG34CostingTemplate/xls/English
  38. 38.
    Conferenza delle Regioni e delle Province Autonome. Tariffa Unica Convenzionale (2011). http://www.regioni.it/download.php?id=254443&field=allegato&module=news
  39. 39.
    InEK GmbH: Auswertung im Rahmen der Begleitforschung für das Datenjahr 2010 (online). URL: http://www.g-drg.de/cms/content/view/full/3489. Accessed 1 Mar 2013
  40. 40.
    InEK GmbH: Fallpauschalen-Katalog 2011 [online]. URL: http://www.g-drg.de/cms/content/view/full/3489. Accessed 1 Mar 2013
  41. 41.
    Ministerio de Sanidad. Servicios Sociales e Igualdad: Registro de Altas de los Hospitales Generales del Sistema Nacional de Salud. CMBD. Norma Estatal- NORMA AÑO 2011 AP 27 (2011)Google Scholar
  42. 42.
    ATIH (Agence Technique de l’Information sur l’Hospitalisation) base des séjours hospitaliers 2011. tousétabliussements. France entièreGoogle Scholar
  43. 43.
    Tariffs for public hospitals according to official tariffs for 2011. Arrêté du 1 mars 2011Google Scholar
  44. 44.
    NHS Reference Costs for England: Financial year 2011 to 2012. 8th November 2012, Department of Health, London. https://www.gov.uk/government/publications/nhs-reference-costs-financial-year-2011-to-2012. Accessed 12 June 2013
  45. 45.
    Hense, H.W., Schulte, H., Lowel, H., et al.: Framingham risk function overestimates risk of coronary heart disease in men and women from Germany—results from the MONICA Augsburg and the PROCAM cohorts. Eur. Heart J. 24(10), 937–945 (2003)PubMedCrossRefGoogle Scholar
  46. 46.
    Gómez-Marcos, M.A., Martínez-Salgado, C., Martin-Cantera, C., Recio-Rodríguez, J.I., Castaño-Sánchez, Y., Giné-Garriga, M., Rodriguez-Sanchez, E., García-Ortiz, L.: Therapeutic implications of selecting the SCORE (European) versus the D’AGOSTINO (American) risk charts for cardiovascular risk assessment in hypertensive patients. BMC Cardiovasc. Disord. 11(9), 17 (2009). doi: 10.1186/1471-2261-9-17 CrossRefGoogle Scholar
  47. 47.
    Gonzalez, C., Rodilla, E., Costa, J.A., Justicia, J., Pascual, J.M.: Cardiovascular risk by Framingham and SCORE in patients 40–65 years old. Med. Clin. (Barc) 126(14), 527–531 (2006)CrossRefGoogle Scholar
  48. 48.
    Maiques Galan, A., Anton Garcia, F., Franch Taix, M., Albert Ros, X., Aleixandre Marti, E., Collado Gil, A.: Cardiovascular risk of SCORE compared to Framingham. Consequences of the change proposed by the European societies. Med. Clin. (Barc) 123(18), 681–685 (2004)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • F. S. Mennini
    • 1
    • 2
  • A. Marcellusi
    • 1
    • 3
    Email author
  • J. M. Graf von der Schulenburg
    • 4
  • A. Gray
    • 5
  • P. Levy
    • 6
  • P. Sciattella
    • 1
  • M. Soro
    • 7
  • G. Staffiero
    • 8
  • J. Zeidler
    • 4
  • A. Maggioni
    • 9
  • R. E. Schmieder
    • 10
  1. 1.Economic Evaluation and HTA (EEHTA), CEIS, Faculty of EconomicsUniversity of Rome “Tor Vergata”RomeItaly
  2. 2.Department of Accounting and Finance at Kingston UniversityLondonUK
  3. 3.Department of DemographyUniversity of Rome “La Sapienza”RomeItaly
  4. 4.Center for Health Economics Research Hannover(CHERH)Leibniz Universität HannoverHannoverGermany
  5. 5.Health Economics Research Centre, Department of Public HealthUniversity of OxfordOxfordUK
  6. 6.PSLUniversité Paris-DauphineParisFrance
  7. 7.Market Access DepartmentDaiichi Sankyo EuropeMunichGermany
  8. 8.Department of Economics and Business, CRESUniversitat Pompeu Fabra BarcelonaBarcelonaSpain
  9. 9.Associazione Nazionale Medici Cardiologi Ospedalieri Research CenterFlorenceItaly
  10. 10.Department of Nephrology and HypertensionUniversity Hospital ErlangenErlangenGermany

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