Leadership Group:
Dyfrig Hughes, PhD, MRPharmS, Reader in Pharmacoeconomics and Deputy Director, Centre for Economics and Policy in Health, IMSCaR, Bangor University, Gwynedd, Wales
Maria Pisu PhD, Assistant Professor, University of Alabama at Birmingham
Maribel Salas, MD, DSc, MSc, Associate Medical Director, US Patient Safety, AstraZeneca, LP
Monali Bhosle PhD, MS, Consultant, IMS Consulting
Pamela Peele PhD, MA, VP, Health Economics, UPMC Health Plan
Rachel Elliot PhD, Clinical Senior Lecturer, University of Nottingham
Warren Cowell  MSc, BSc, Health Economist, Bayer
Tamas Koncz MD, EMEA Medical Communication Lead, Bristol Myers Squibb

1. Methods for considering medication compliance and persistence in pharmacoeconomic evaluations
2. Understanding non-compliance and non-persistence using an economic framework
3. What is the cost to healthcare systems of non-compliance and non-persistence?
4. Efficacy versus effectiveness: what is the contribution of non-compliance and non-persistence?, and what impact does this have on cost-effectiveness?
5. Identification of drugs where compliance is critical for clinical and cost-effectiveness.

1. Compile a reference list of economic studies analysing the cost-effectiveness of interventions aimed at promoting compliance - task completed (The Annals of Pharmacotherapy 2005; 39: 508-15)
   
   Excerpt:
   We were not able to make definitive conclusions about the cost-effectiveness of adherence-enhancing interventions due to the heterogeneity of the studies found and incomplete reporting of results. Important policy decisions need to be made about non-adherence; however, they are currently being made in a vacuum of adequate information. Adherence-enhancing interventions must be based on reasons for non-adherence and be evaluated using accepted clinical and economic quality criteria.
    
2. Develop recommendations on how pharmacoeconomic evaluations should account for non-compliance and non-persistence in line with standard economic evaluation methodological guidelines - Manuscript Accepted by Value in Health Published On-line
   
   Methods for Integrating Medication Compliance and Persistence in Pharmacoeconomic Evaluations
   Dyfrig Hughes PhDMSc, Warren Cowell MScBSc, Tamas Koncz MD, Joyce Cramer BS
   Value in Health (OnlineEarly Articles).
   doi:10.1111/j.1524-4733.2007.00205.x
   
   Excerpt:
   Pharmacoeconomic evaluations assess whether incremental improvements in outcome associated with a given drug, justify the cost. The specific nature of this assessment can take various forms, but essentially requires a comparison of alternative medicines’ costs and benefits. Many factors impact on these costs and benefits, one of which is how ‘well’ the medicines are taken. Sub-optimal compliance and /or failure to persist with therapy for the prescribed duration, account for many of the observed differences between efficacy and clinical effectiveness. The purpose of this paper is to highlight the importance of considering compliance and persistence in pharmacoeconomic analyses, with the aim of developing recommendations on how pharmacoeconomic evaluations should account for medication non-compliance and non-persistence, in line with standard economic evaluation methodological guidelines.
   
   
   
3. Understanding medication non-compliance and non-persistence using an economic framework - Manuscript Submitted to Value in Health
   
   Excerpt:
   There is increasing awareness that medication compliance and persistence are a complex area of human behaviour, and explanations of patients’ non-adherence with prescribed treatments have been attempted from many perspectives. Most commonly, an epidemiological approach has looked at identifying ‘at risk’ groups for non-compliance. Sociological and psychological frameworks have afforded greater understanding of non-compliance with medicines, by suggesting that intentional non-compliance is not a deviant behaviour that stems from ignorance or particular socio-demographic characteristics. More recently, economists have worked with psychologist to examine people’s choice behaviour more closely. In this paper we present an argument for the use of these economic models to further explain medication non-compliance and non-persistence.
    
4. What are the costs of non-compliance and non-persistence in osteoporosis, diabetes, hypercholesterolaemia and depression?
   
   Systematic reviews are under way to assess the monetary impact of non-compliance and non-persistence in four disease areas. The aim will be to quantify the cost, and model the global financial impact on healthcare systems. Volunteers to assist with this task are sought. E-mail: medcompsig@ispor.org
    
5. Dissemination through ISPOR conference workshops:
   - Patient compliance and persistence with prescribed medication: Measurement and health economic impact, Washington 2004
   - Incorporating measures of compliance and persistence in pharmacoeconomic evaluations, Florence 2005

1. Focus on goals (2) and (3), and other issues of high interest identified by the SIG
2. Present findings at ISPOR conferences, and publish in peer reviewed journals
3. Article(s) for ISPOR Connections