Achieving Patient Buy-In and Long Term Compliance with Antihypertensive Treatment

Noncompliance is a major problem in antihypertensive treatment. Up to 50% of patients are noncompliant after 1 year and 85% after 5 years. Current approaches for predicting compliance are based on patient demographics, medication characteristics and clinical factors, health beliefs and the quality of patient-provider communication. All of these factors together predict compliance only less than half the time, indicating that over half of the patients in disease management programmes may not buy-in to their treatment. A new approach views compliance as behaviour change that takes place over time. Patients move through 5 stages in their `readiness to comply'. Our study of over 700 patients with hypertension using brief self-report measures to assess their `readiness to comply' found a highly significant relationship between `readiness to comply' and reported compliance. Clinicians can increase patient buy-in and long term compliance by assessing their patients `stage-of-change' using validated measures and then matching their interventions to each patient's `readiness to comply'.Antihypertensives, Hypertension, Patient compliance, Pharmacoeconomics

Assessment of Health Economics in Alzheimer's Disease (AHEAD): Treatment with Galantamine in Sweden

Background: Like other developed countries with aging populations, Sweden is expecting large increases in the prevalence of Alzheimer's disease and corresponding escalations in the cost of care for patients with this disease. Galantamine, a new acetylcholinesterase inhibitor and nicotinic modulator, has proved effective in managing patients with Alzheimer's disease in clinical trials. Objective: To estimate the long-term health and economic impact of galantamine from the perspective of the public health payer in Sweden. Design and setting: The Assessment of Health Economics in Alzheimer's Disease (AHEAD) model compares galantamine treatment with no pharmacologic treatment. It consists of a module based on trial data followed by a projection module that uses the trial results to predict the time until patients require full-time care (FTC) or until their death. Forecasts were made for up to 10 years. The model was customised to Sweden by using Swedish resource use profiles obtained from the literature. Results: Galantamine is predicted to reduce the time patients require FTC by almost 10%. Approximately 5.6 patients with mild-to-moderate disease would need to be treated to avoid one year of FTC. This would result in savings averaging 27 436 Swedish kronas (SEK) [3131 euros (EUR)] per patient over 10 years (1998 values). To avoid one year of FTC, 3.9 patients with moderate disease would need to be treated, with savings averaging SEK49 019 (EUR5594) per patient over 10.5 years. Sensitivity analyses of key parameters, such as proportion of patients needing FTC treated in the community, cost of care in an institution, cost of FTC care in the community, the price of galantamine, and the discount rate, found savings with galantamine would occur under most circumstances. Conclusion: Galantamine can increase the time before patients require FTC, and may also lead to savings as treatment costs are offset by reductions in other healthcare expenditures and the costs associated with FTC.Acetylcholinesterase inhibitors, Alzheimer's disease, Cost effectiveness, Galantamine, Pharmacoeconomics