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.