Abstract 15092: Projected Cost Saving With Optimal Medication Adherence in Cardiovascular Disease Patients Requiring Lipid Lowering Agents in Mexico and Thailand
Jeong-Yeon Cho, Fernando A. Wilson, Usa Chaikledkaew, Arintaya Phrommintikul, Kyoo Kim, Nathorn Chaiyakunapruk- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: Adherence to chronic cardiovascular treatments is less than 50% in developing countries, which impedes achieving targeted clinical outcomes. This study aims to estimate potential benefits of improving adherence in CVD patients requiring secondary prevention.
Methods: We performed state-transition Markov model simulation for secondary CVD prevention in Mexico and Thailand. Stakeholders were engaged based on CHEERS II guideline. The analyses were performed upon a healthcare system perspective for a lifetime horizon. Two scenarios were compared: (1)optimal adherence (which is simulated based on mean adherence from a meta-analysis of 51 RCTs), and (2) status quo. The association of adherence and CVD outcomes (MI and stroke) is based on a dose-response meta-analysis of observational studies of 4,051,338 patients. Direct medical costs are obtained from literature review. Outcomes are accumulated number of CVD events and associated costs in 2022 USD, life-year, and quality-adjusted life years (QALYs). Sensitivity analyses were performed to assess the robustness of our findings.
Results: Status quo in both countries were expected to have a higher risk of CVD than optimal adherence (Mexico: RR 1.22, 95% CI 1.17-1.28; Thailand: RR 1.21, 95% CI 1.16-1.26). The number needed to treat to prevent one additional CV event was 25.02 and 29.37, respectively. Consequently, achieving optimal adherence can increase life-year by 0.60, 0.84 and QALYs by 0.59 and 0.68 in Mexico and Thailand, respectively. Moreover, this could avert CV event-related medical costs of $614 and $313. When lipid lowering therapy costs are included, the optimal adherence scenario results in cost saving with $418 in Mexico and $293 in Thailand. Cost saving findings are robust across all sensitivity analyses.
Conclusion: In developing countries, patients requiring lipid lowering agents for secondary CVD prevention suffer from preventable outcomes due to their suboptimal medication adherence. It is recommended to consider various methods of improving adherence that could result in cost savings and achieving therapeutic goals.