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

Abstract

The study by Mennini et al. [1] uses a decision model to assess cost implications of improving adherence to medication in hypertensive patients in five European countries (England, France, Germany, Italy, and Spain) from a payer’s perspective over 10 years. To this end, the model predicts the 10-year risk for cardiovascular events based on the Framingham risk equation. In terms of costs, it considers drug and hospitalization costs. The model suggests savings through avoiding cardiovascular events in each of the five countries. Leaving aside a lack of consideration of costs of (a) medication side effects, (b) outpatient care, (c) rehabilitation, and (d) life extension, this result cannot be replicated based on the input data listed in the publication. This points to a potential lack of internal validity. To explain, consider that the net cost of making one additional patient adherent to blood pressure (BP) medication can be calculated in two steps: