LAUSR

The report by van Schoonhoven et al, “Cost-utility of an objective biochemical measure to improve adherence to antihypertensive treatment,” provides evidence that detecting and monitoring nonadherence in patients with uncontrolled hypertension can be cost saving. Based on repeated simulations in 10 000 men 65 years old, biochemical detection and monitoring of nonadherence to antihypertensive medications would prevent 518 myocardial infarctions and 305 stroke events, increase qualityadjusted life years by 0.020, and save £1192 or ≈$1585 US. The authors have worked diligently on this important topic in recent years. Their previous work shows that antihypertensive medications can be reliably detected in urine or blood using liquid-chromatography tandem mass spectroscopy (LC-MS/ MS). Moreover, using LC-MS/MS to detect and monitor nonadherence led to clinically and statistically significant reductions in blood pressure (BP, mm Hg) among adults with uncontrolled hypertension in both the United Kingdom and Czech Republic. In the UK study, which provided the basis for the economic analysis, 31% of hypertensive patients (73/238) were nonadherent defined by the absence of ≥1 prescribed BP medications in their urine by LC-MS/MS. Baseline BP of nonadherent patients was 167.8/94.8 and fell in a subset of 17 of these patients to 143.3/87.3 with serial adherence monitoring. Adherence rose from 33% to 100%, while the mean number of prescribed antihypertensive medications remained at 4. Larger reductions of BP were reported with therapeutic adherence monitoring in the Czech Republic, although follow-up monitoring data were not provided.