Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review

Njie, Gibril J.; Finnie, Ramona; Acharya, Subrata; Jacob, Verughese; Proia, Krista; Hopkins, David P.; Pronk, Nicolaas P.; Goetzel, Ron Z.; Kottke, Thomas E.; Rask, Kimberly J.; Lackland, Daniel T.; Braun, Lynne T.

doi:10.5888/pcd12.150242

Cited by 22 publications

(27 citation statements)

References 35 publications

(114 reference statements)

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“…that informs prescribing decisions (15,16); and implementing payment reforms that decrease spending, such as limiting deductibles and copayments (20). Although annual out-ofpocket antihypertensive spending for most beneficiaries was low (around $100 per year), it represented almost one fifth of their total prescription medication spending and might be a barrier to adherence among certain groups.…”

Section: Conclusion and Commentsmentioning

confidence: 99%

Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014

Ritchey¹,

Chang²,

Powers³

et al. 2016

MMWR Morb. Mortal. Wkly. Rep.

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Introduction: Nonadherence to taking prescribed antihypertensive medication (antihypertensive) regimens has been identified as a leading cause of poor blood pressure control among persons with hypertension and an important risk factor for adverse cardiovascular disease outcomes. CDC and the Centers for Medicare and Medicaid Services analyzed geographic, racial-ethnic, and other disparities in nonadherence to antihypertensives among Medicare Part D beneficiaries in 2014. Methods: Antihypertensive nonadherence, defined as a proportion of days a beneficiary was covered with antihypertensives of <80%, was assessed using prescription drug claims data among Medicare Advantage or Medicare fee-for-service beneficiaries aged ≥65 years with Medicare Part D coverage during 2014 (N = 18.5 million). Analyses were stratified by antihypertensive class, beneficiaries' state and county of residence, type of prescription drug plan, and treatment and demographic characteristics. Conclusions and Implications for Public Health Practice: More than one in four Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen, and certain racial/ethnic groups, states, and geographic areas were at increased risk for nonadherence. These findings can help inform focused interventions among these groups, which might improve blood pressure control and cardiovascular disease outcomes.

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Section: Conclusion and Commentsmentioning

confidence: 99%

Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014

Ritchey¹,

Chang²,

Powers³

et al. 2016

MMWR Morb. Mortal. Wkly. Rep.

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“…System‐level and community‐linked interventions, such as those recommended by the Community Preventive Services Task Force (http://www.thecommunityguide.org/topic/cardiovascular-disease), should be promoted. Sustainable interventions and examples from the task force to improve hypertension control relevant for this context include reducing out‐of‐pocket costs and integrating team‐based care into the clinical environment …”

Section: Discussionmentioning

confidence: 99%

“…Sustainable interventions and examples from the task force to improve hypertension control relevant for this context include reducing out-of-pocket costs and integrating team-based care into the clinical environment. 32…”

Section: Perspectivesmentioning

confidence: 99%

Insurance Status Among Adults With Hypertension—The Impact of Underinsurance

Fang

Zhao

Wang

et al. 2016

JAHA

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BackgroundHypertension is a major risk factor for heart disease and stroke. Health insurance coverage affects hypertension treatment and control, but limited information is available for US adults with hypertension who are classified as underinsured.Methods and ResultsUsing Behavioral Risk Factor Surveillance System 2013 data, we identified adults with self‐reported hypertension. On the basis of self‐reported health insurance status and health care–related financial burdens, participants were categorized as uninsured, underinsured, or adequately insured. Proxies for health care received included whether they reported taking antihypertensive medications and whether they visited a doctor for a routine checkup in the past year. We assessed the association between health insurance status and health care received, adjusting for selected sociodemographic characteristics. Among 123 257 participants from 38 states and District of Columbia with self‐reported hypertension, 12% were uninsured, 26% were underinsured, and 62% were adequately insured. In adjusted models using adequately insured participants as referent, both uninsured (adjusted odds ratio, 0.39; 95% CI, 0.35–0.43) and underinsured (0.83, 0.76–0.89) participants were less likely to report using antihypertensive medication than those of adequately insured participants. Similarly, adjusted odds ratio of visiting a doctor for routine checkup in the past year were 0.25 (0.23–0.28) for those who were uninsured and 0.78 (0.72–0.84) for those who were underinsured compared to those with adequate insurance.ConclusionsUninsured and underinsured participants with hypertension were less likely to report receiving care compared to those with adequate insurance coverage. Disparities in health care coverage may necessitate targeted interventions, even among people with health insurance.

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“…1,2,4–7 According to Community Guide processes, since the Task Force recommended all five interventions based on evidence of their effectiveness, systematic economic reviews were subsequently completed. 3,5,8,9 …”

Section: Methodsmentioning

confidence: 99%

Community Guide Cardiovascular Disease Economic Reviews: Tailoring Methods to Ensure Utility of Findings

Chattopadhyay

Jacob

Mercer

et al. 2017

American Journal of Preventive Medicine

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Context: The Community Preventive Services Task Force recommended five interventions for cardiovascular disease (CVD) prevention between 2012 and 2015. Systematic economic reviews of these interventions faced challenges that made it difficult to generate meaningful policy and programmatic conclusions. Objectives: This paper describes the methods used to assess, synthesize, and evaluate the economic evidence to generate valid, reliable, and useful economic conclusions and address the comparability of economic findings across interventions. Methods: Steps were taken to assess completeness of data and identify the components and drivers of cost and benefit. Except for intervention cost of self-measured blood pressure monitoring (SMBP) intervention, either alone or with patient support, all cost and benefit estimates were standardized as per patient per year. When possible, intermediate outcomes were converted to quality-adjusted life year (QALY). Differences within and between interventions were considered to generate economic conclusions and inform their comparability. Results. Intervention cost per patient per year was highest for team-based care (TBC), either alone or in combination with other interventions. TBC, SMBP with patient support, and SMBP within TBC were found to be cost-effective; however their cost-effectiveness estimates were not comparable because of differences in the intervention characteristics. Lack of enough data and/or incomplete information made it difficult to reach an overall economic finding for the other interventions. Conclusions: Appropriate methods to handle the complexity of systematic economic reviews can help to draw transparent and valid economic conclusions for public health interventions to prevent or control CVD and inform judgment about their comparability.

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Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review

Cited by 22 publications

References 35 publications

Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014

Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014

Insurance Status Among Adults With Hypertension—The Impact of Underinsurance

Community Guide Cardiovascular Disease Economic Reviews: Tailoring Methods to Ensure Utility of Findings

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