Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review
SYSTEMATIC REVIEW — Volume 12 — November 26, 2015
The topic of this systematic review was reduced out-of-pocket costs (ROPC) for cardiovascular disease (CVD) preventive services for patients with hypertension or hyperlipidemia (top left, in oval). This topic is connected by an arrow to a rounded box labelled “Reduced financial barriers to evidence-based treatments for patients identified with hypertension or hyperlipidemia (or both).” An arrow connects this box with another, headed in bold, “Increased use of evidence-based preventive services by patients.” A list of 4 areas for which costs might be reduced follows: medications; counseling; behavioral support, and tobacco cessation. Three types of counseling are listed: diet, physical activity, and obesity/weight loss. An asterisk after tobacco cessation indicates that this topic is covered in a different Community Guide review. Other arrows link this box with 6 possible benefits of ROPC: improved patient experience with care, reduced health disparities, reduced CVD illness and death, reduced CVD risk factors, increased treatment adherence, and increased healthy behaviors. Each of the benefits points to the next. A hexagon bordered by a dotted line lists potential effect modifiers: awareness (with subheads “patient/provider” and “health literacy”); covered service(s); ROPC format (magnitude); patient/provider resources, support; and additional interventions. An arrow links the hexagon to a rounded box titled improved patient–provider interaction. This box is in turn linked to “increased motivation for patients and providers,” which has arrows linked to 3 others: increased healthy behaviors, increased treatment adherence, and the central rounded box titled increased use of evidence-based preventive services by patients (already described).
Figure 1. Analytic framework: reduced out-of-pocket costs (ROPC) for cardiovascular disease (CVD) preventive services for patients with hypertension or hyperlipidemia.
The figure describes the search process (January 1980 through July 2015). The top box shows that the team began with 11,418 articles, of which 11,057 were deemed not relevant or duplicates, leaving 361 potentially relevant articles. Of these, 314 were excluded as not ROPC interventions. The team ordered 47 full-text articles and found 26 that did not meet inclusion criteria, 2 for which no full text was found, and 1 of limited quality. These exclusions left 18 interventions studies that met inclusion criteria and were included in analysis.
Figure 2. Flow diagram, showing number of studies identified, reviewed in full text, reasons for exclusion, and total number of included studies. Abbreviation: ROPC, reducing patient out-of-pocket costs.
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