Presentation (CTI)

OBJECTIVES: Cardiovascular disease (CVD) is a leading global health burden, requiring economic evaluations to inform healthcare resource allocation. A majority utilize decision-analytic models to project costs and outcomes, though perfect patient adherence is often assumed, potentially biasing evaluations. This systematic review aimed to determine the extent to which patient adherence is modeled in cardiovascular economic evaluations and to explore its potential impact on clinical and economic outcomes.
METHODS: We systematically searched Embase and the Tufts CEA Registry using an adherence-specific strategy and subsequently conducted the same search while excluding adherence-related search terms. Screening from the adherence-focused search identified relevant publications. The review focused on major therapeutic areas such as hypertension, atherosclerotic cardiovascular disease, and atrial fibrillation. The data extracted included whether and how adherence was modelled, the assumptions made, and the reported influence on clinical and economic outcomes.
RESULTS: The adherence-focused search yielded 1,247 publications across both databases. This contrasted with 24,220 publications identified from the search omitting adherence terms conducted in Embase. From 1,247 adherence-focused records, 29 were economic evaluations that explicitly modeled adherence or discussed its omission as a limitation. In studies that modeled adherence, observations suggested that higher adherence was associated with improved clinical and economic outcomes, such as lower incremental cost-effectiveness ratios, reduced healthcare costs, and lower incidence of cardiovascular events. A frequently cited challenge that contributed to adherence omission was the difficulty in obtaining robust real-world adherence data.
CONCLUSIONS: The observed difference in publication volume between the adherence-specific and broader general search suggests underutilization of adherence modeling in health economic literature. The reviewed studies highlight the importance of incorporating realistic adherence assumptions in economic evaluations. Standardized methodologies and improved real-world data collection could provide important additional information in cardiovascular economic evaluations and better align evaluation findings with routine clinical practice.