OBJECTIVES: This study aimed to adapt the "My Health Everyday" medication adherence coaching application, originally developed in Poland, for use in Hungary; and to evaluate the cost-effectiveness of the adapted application compared to usual care among adults with hypertension, considering the perspective of the Hungarian healthcare payer.

METHODS: The study, conducted from January to June 2023, involved a 5-step translation process of the application: Polish to English translation, English to Hungarian translation, expert panel review, patient pre-testing, and final iteration. A decision-analytic Markov cohort model with a 12-month time horizon was developed, utilizing literature-based model parameters. The application was estimated to improve medication adherence to anti-hypertensives by 20%. The primary outcome measure was the incremental cost-effectiveness ratio (ICER) and one way deterministic analysis was conducted to examine parameter uncertainty. Additionally, the study considered the estimation of the value-based price of the application, taking into account the Hungarian cost-effectiveness threshold.

RESULTS: Translation challenges emerged due to differences between the Polish and Hungarian healthcare systems, medical terminology, and other cross-cultural aspects. The Hungarian version of the application consisted of 72 patient advice items (Polish version had 79 items). Assuming the cost of the application to be “free”, the ICER analysis demonstrated the coaching application's dominance over usual care. Patients with improved adherence achieved an estimated gain of 0.0001 quality-adjusted life years (QALYs) over 12 months. In a population of 1,000 patients, the application was projected to prevent 1.8 cases of stroke, coronary heart disease, or heart failure, along with 0.2 deaths.

CONCLUSIONS: The adapted medication adherence coaching application holds promise for enhancing hypertension management in Hungary. Our findings underscore the importance of cross-cultural and conceptual adaptation when introducing healthcare applications across different countries. Furthermore, evaluating cost-effectiveness prior to implementation is crucial for informed decision-making.