OBJECTIVES:In this study, we seek to measure the association between physicianrated adherence to antihypertensive treatment and blood pressure outcomes. Prior to the study, we hypothesized that systolic and diastolic blood pressure outcomes were also related with patient and physician variables. Therefore, we also seek to determine the impact of these variables on the outcome. METHODS: Unlike prior adherence studies, which have consulted small sample sizes by means of timeconsuming and complex questionnaires, our research pools the findings from six Valsartan studies, thereby evaluating 15,583 patients, while utilizing a simple and cost-effective survey method. Adherence was measured using a four-item yes/no Basel Assessment for Adherence Scale (BAAS), in which a "yes" answer on any item classified a patient as non-adherent. The measurements were performed at baseline and at 90 days. Hierarchical logistic regression was used to identify patientand physician-related determinants. RESULTS: Our results indicate that inadequate blood pressure control correlates with poor adherence at baseline and 90 days. The mean absolute difference in blood pressure between those who were adherent (70% of the patient population) and those who were not was 5 to 19 mmHg (pϽ0.001). Every adherent patient was likely to decrease his systolic and diastolic blood pressure by 2.3 and 1.3 mmHg, respectively (pϽ0.001). The majority of the variability in blood pressure values, however, was due to patient variables, many of which can be managed with medical care, or identified in patients with higher risks, poor adherence, or poly-pharmacy. CONCLUSIONS: Physician-reported adherence by means of a short patient BAAS questionnaire is a direct, simple and especially inexpensive method to assess adherence status. This method can be easily integrated into routine clinical practice and provides evidence that adherence is positively correlated with blood pressure reduction in hypertensive patients. However, patient-related variables also correlate strongly with the outcome and demand further investigation.
mation were calculated. RESULTS: Taking into account the results from MC simulations, the PTA/S alternative is the most expensive and less effective (€ 24,581 and 6.857 QALYs), but attending to small differences and the large variability on results between alternatives, these results are not conclusive. The least costly alternative is PTA/S/BP (€ 18,351), with an effectiveness of 7.049 QALYs. PTA/S/BP shows higher effectiveness than PTA/S, but lower effectiveness than BP (7.281 QALYs). The cost of the BP alternative is € 24,056. PTA/S/BP and BP alternatives show higher probabilities of being efficient alternatives. If the willingness to pay is € 30,000/QALY, opportunity cost of implementing PTA/S/BP would exceed € 15,000 per patient treated. CONCLUSIONS: Although the results of effectiveness identified PTA/S/BP as the most efficient alternative for a willingness to pay less than € 40,000/QALY, the probability of making a proper decision is only about 50%. This situation, together with the high opportunity costs, encourages the development of new clinical trials or observational studies in our environment in order to remove uncertainty over the results.
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