Published Jun 2007
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.
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.
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- Methods for Measuring Multiple Medication Adherence: A Systematic Review
- Initial Medication Adherence - Review and Recommendations for Good Practices in Outcomes Research: An ISPOR Medication Adherence and Persistence Special Interest Group Report
- Medication Compliance and Persistence: Terminology and Definitions
- Checklist for Medication Compliance and Persistence Studies Using Retrospective Databases
- Understanding Medication Compliance and Persistence from an Economics Perspective
- Costs of Medication Non adherence in Patients with Diabetes Mellitus: A Systematic Review and Critical Analysis of the Literature
- Impact of Interventions on Medication Adherence and Blood Pressure Control in Patients with Essential Hypertension: A Systematic Review by the ISPOR Medication Adherence and Persistence Special Interest Group
- Systematic Literature Review of Psychosocial and Behavioral Factors Associated with Initial Medication Adherence