Methods for Integrating Medication Compliance and Persistence in Pharmacoeconomic Evaluations

Published Dec 2019

Citation

Hughes D, Cowell W, Koncz T, Cramer J. Methods for Integrating Medication Compliance and Persistence in Pharmacoeconomic Evaluations. Value in Health. 2007;10(6):498-509.

Abstract

Objectives: Suboptimal compliance and failure to persist with drug treatments are important determinants of therapeutic nonresponse and are of potential economic significance. The present article aims to describe the methodologies that may be appropriate for integrating noncompliance and nonpersistence in economic evaluations.

Methods: MEDLINE and NHS‐EED were searched for economic evaluations published in the period between 1997 and 2005. Articles were included if they explored the dependence of cost‐effectiveness results on varying levels of some form of compliance‐related measure. The different methodologies used were reviewed and articles were appraised critically. Alternative methodological approaches are proposed, illustrated by an example of the impact of different persistence rates on a treatment's cost‐effectiveness.

Results: Ten articles were selected for inclusion. These were generally scant on detail relating to how compliance/persistence was assessed and what the impact was on health outcomes. The methods used included Markov models and decision analyses. Markov models allow for persistence to be included directly in the analysis, as patients transit during each cycle. Net‐benefit regression models are well suited for analyzing prospective and retrospective studies where patient‐level data are available, whereas discrete event simulations have the potential to offer more flexibility.

Conclusions: Compliance and/or persistence are not included routinely in pharmacoeconomic analyses, despite their potential impact. Where compliance and/or persistence are included, a lack of methodological rigor and consistency in definitions often limits the usefulness of the analyses. The analytical techniques discussed in this article should serve as a basis for developing guidelines on appropriate methodology.

Full Content

Download PDF

Questions?

For any questions about this report please contact us.

Your browser is out-of-date

ISPOR recommends that you update your browser for more security, speed and the best experience on ispor.org. Update my browser now

×