Antihypertensive Medication Adherence and Medical Costs, Health Care Utilization, and Labor Productivity among Persons with Hypertension

Background: Hypertension affects nearly half of U.S. adults, yet remains inadequately controlled in over three-quarters of these cases. This study aims to assess the association between adherence to antihypertensive medications and total medical costs, health care utilization, and productivity-related outcomes. Methods: We conducted a retrospective cohort study using MarketScan databases, which included individuals aged 18?64 with non-capitated health insurance plans in 2019. Adherence was defined as ?80% Medication Possession Ratio (MPR) for prescribed antihypertensive medications. We used a generalized linear model to estimate total medical costs, a negative binomial model to estimate health care utilization (emergency department visits and inpatient admissions), an exponential hurdle model to estimate productivity-related outcomes (number of sick absences, short-term disability [STD], long-term disability [LTD]), and a two-part model to estimate productivity-related costs in 2019 U.S. dollars. All models were adjusted for age, sex, urbanicity, census region, and comorbidities. We reported average marginal effects for outcomes related to antihypertensive medication adherence. Results: Among 379,503 individuals with hypertension in 2019, 54.4% adhered to antihypertensives. Per-person, antihypertensive medication adherence was associated with $1,441 lower total medical costs, $11 lower sick absence costs, $291 lower STD costs, and $69 lower LTD costs. Per 1,000 individuals, medication adherence was associated with lower healthcare utilization, including 200 fewer ED visits and 90 fewer inpatient admissions, and productivity-related outcomes, including 20 fewer sick absence days and 442 fewer STD days. Conclusions: Adherence to antihypertensives was consistently associated with lower total medical costs, reduced healthcare utilization, and improved productivity-related outcomes. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NA ### Funding Statement The authors received no financial support for the research, authorship, and/or publication of this article. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study involved secondary data analysis using de-identified information and was categorized as non-research and thus exempt from Institutional Review Board review. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data is not publicly available due to data user agreement, but the program codes are available upon request to the corresponding author.