Cost of Poor Adherence to Anti-Hypertensive Therapy in Europe

19 Pages Posted: 15 Dec 2013

See all articles by Francesco Mennini

Francesco Mennini

University of Rome Tor Vergata - Centre for International Studies on Economic Growth (CEIS); Kingston University - School of Accounting and Finance

Andrea Marcellusi

University of Rome Tor Vergata - Centre for International Studies on Economic Growth (CEIS); University of Rome I

J. Matthias Graf von der Schulenburg

Independent

Alastair Gray

University of Oxford - Health Economics Research Centre (HERC)

Pierre L. Levy

Université Paris Dauphine

Paolo Sciattella

University of Rome Tor Vergata - Centre for International Studies on Economic Growth (CEIS)

Marco Soro

Daiichi Sankyo Europe

Gianandrea Staffiero

Universitat Pompeu Fabra - Department of Economics and Business

Jan Zeidler

Center for Health Economics Research Hannover (CHERH)

Aldo Pietro Maggioni

National Association of Hospital Cardiologists Research Center

Roland Schmieder

University Hospital Erlangen

Date Written: December 13, 2013

Abstract

Background: The financial burden for EU health systems associated with cardiovascular disease 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 5 European countries (Italy, Germany, France, Spain and England).

Methods: A probabilistic prevalence-based decision tree model was developed to estimate the direct costs of cardiovascular disease related to hypertension (CV defined as: stroke, heart attack, kidney disease, heart failure) in 5 European countries. Our model considered adherence to hypertension treatment as a main driver of blood pressure 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 Health System (NHS) perspective for 10 years was considered. Probabilistic Sensitivity Analysis (PSA) was performed in order to evaluate uncertainty around the results (given as 95% confidence intervals).

Results: 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 NHS perspective, the direct cost associated with hypertension was estimated to be € 51.1 billion (8.1 in Italy, 17.8 in Germany, 12.2 in Spain, 8.8 in France and 4.1 in England). Increasing adherence to anti-hypertensive therapy to 70% would save a total of € 323.7 million (CI 95%: € 304.2 - € 342.2 million) from the NHSs perspective.

Conclusion: This study is the first attempt to estimate the economic impact of nonadherence amongst patients with diagnosed hypertension in Europe, using data from five European countries (Italy, France, Germany, Spain and England).

Suggested Citation

Mennini, Francesco and Marcellusi, Andrea and von der Schulenburg, J. Matthias Graf and Gray, Alastair and Levy, Pierre L. and Sciattella, Paolo and Soro, Marco and Staffiero, Gianandrea and Zeidler, Jan and Maggioni, Aldo Pietro and Schmieder, Roland, Cost of Poor Adherence to Anti-Hypertensive Therapy in Europe (December 13, 2013). CEIS Working Paper No. 299, Available at SSRN: https://ssrn.com/abstract=2367422 or http://dx.doi.org/10.2139/ssrn.2367422

Francesco Mennini (Contact Author)

University of Rome Tor Vergata - Centre for International Studies on Economic Growth (CEIS) ( email )

Via Columbia, 2
Rome, I-00133
Italy

Kingston University - School of Accounting and Finance ( email )

United Kingdom

Andrea Marcellusi

University of Rome Tor Vergata - Centre for International Studies on Economic Growth (CEIS) ( email )

Via Columbia, 2
Rome, I-00133
Italy

University of Rome I ( email )

Rome
Italy

Alastair Gray

University of Oxford - Health Economics Research Centre (HERC) ( email )

Department of Public Health
Old Road Campus
Oxford OX3 7LF
United Kingdom
+44 (0)1865 226885 (Phone)
+44 (0)1865 226842 (Fax)

Pierre L. Levy

Université Paris Dauphine ( email )

223 Rue Saint-Honore
Paris, 75775
France

Paolo Sciattella

University of Rome Tor Vergata - Centre for International Studies on Economic Growth (CEIS) ( email )

Via Columbia, 2
Rome, I-00133
Italy

Marco Soro

Daiichi Sankyo Europe ( email )

Zielstattstraße 48
Minich
Germany

Gianandrea Staffiero

Universitat Pompeu Fabra - Department of Economics and Business ( email )

Barcelona
Spain

Jan Zeidler

Center for Health Economics Research Hannover (CHERH) ( email )

Königsworther Platz 1
Hannover, 30167
Germany

Aldo Pietro Maggioni

National Association of Hospital Cardiologists Research Center ( email )

Via La Marmora 36
Florence, 50121
Italy

Roland Schmieder

University Hospital Erlangen ( email )

Maximiliansplatz 2
Erlangen, 91054
Germany

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