TY - JOUR
T1 - Potential cost-effectiveness of therapeutic drug monitoring in patients with resistant hypertension
AU - Chung, Oliver
AU - Vongpatanasin, Wanpen
AU - Bonaventura, Klaus
AU - Lotan, Yair
AU - Sohns, Christian
AU - Haverkamp, Wilhelm
AU - Dorenkamp, Marc
N1 - Publisher Copyright:
Copyright © Lippincott Williams & Wilkins.
PY - 2014
Y1 - 2014
N2 - Background: Nonadherence to drug therapy poses a significant problem in the treatment of patients with presumed resistant hypertension. It has been shown that therapeutic drug monitoring (TDM) is a useful tool for detecting nonadherence and identifying barriers to treatment adherence, leading to effective blood pressure (BP) control. However, the cost-effectiveness of TDM in the management of resistant hypertension has not been investigated. Method: A Markov model was used to evaluate life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios in resistant hypertension patients receiving either TDM optimized therapy or standard best medical therapy. The model ran from the age of 30 to 100 years or death, using a cycle length of 1 year. Efficacy of TDM was modeled by reducing risk of hypertension-related morbidity and mortality. Cost analyses were performed from a payer's perspective. Deterministic and probabilistic sensitivity analyses were conducted. Results: In the age group of 60-year olds, TDM gained 1.07 QALYs in men and 0.97 QALYs in women at additional costs of €3854 and €3922, respectively. Given a willingness-to-pay threshold of €35 000 per QALY gained, the probability of TDM being cost-effective was 95% or more in all age groups from 30 to 90 years. Results were influenced mostly by the frequency of TDM testing, the rate of nonresponders to TDM, and the magnitude of effect of TDM on BP. Conclusion: Therapeutic drug monitoring presents a potential cost-effective healthcare intervention in patients diagnosed with resistant hypertension. Importantly, this finding is valid for a wide range of patients, independent of sex and age.
AB - Background: Nonadherence to drug therapy poses a significant problem in the treatment of patients with presumed resistant hypertension. It has been shown that therapeutic drug monitoring (TDM) is a useful tool for detecting nonadherence and identifying barriers to treatment adherence, leading to effective blood pressure (BP) control. However, the cost-effectiveness of TDM in the management of resistant hypertension has not been investigated. Method: A Markov model was used to evaluate life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios in resistant hypertension patients receiving either TDM optimized therapy or standard best medical therapy. The model ran from the age of 30 to 100 years or death, using a cycle length of 1 year. Efficacy of TDM was modeled by reducing risk of hypertension-related morbidity and mortality. Cost analyses were performed from a payer's perspective. Deterministic and probabilistic sensitivity analyses were conducted. Results: In the age group of 60-year olds, TDM gained 1.07 QALYs in men and 0.97 QALYs in women at additional costs of €3854 and €3922, respectively. Given a willingness-to-pay threshold of €35 000 per QALY gained, the probability of TDM being cost-effective was 95% or more in all age groups from 30 to 90 years. Results were influenced mostly by the frequency of TDM testing, the rate of nonresponders to TDM, and the magnitude of effect of TDM on BP. Conclusion: Therapeutic drug monitoring presents a potential cost-effective healthcare intervention in patients diagnosed with resistant hypertension. Importantly, this finding is valid for a wide range of patients, independent of sex and age.
KW - Cardiovascular diseases
KW - Cost and cost analysis
KW - Cost-benefit analysis
KW - Drug monitoring
KW - Hypertension
KW - Medication adherence
KW - Probability
KW - Risk assessment
UR - http://www.scopus.com/inward/record.url?scp=84927786253&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84927786253&partnerID=8YFLogxK
U2 - 10.1097/HJH.0000000000000346
DO - 10.1097/HJH.0000000000000346
M3 - Article
C2 - 25255395
AN - SCOPUS:84927786253
SN - 0263-6352
VL - 32
SP - 2411
EP - 2421
JO - Journal of hypertension
JF - Journal of hypertension
IS - 12
ER -