Presentation (CTI)

OBJECTIVES: Medication non-adherence is a documented driver of avoidable health expenditure, but no bottom-up estimate exists for Morocco. ADHERE-MA quantifies the annual economic burden of non-adherence across major chronic disease areas, from a Moroccan payer and societal perspective, to distinguish avoidable cost and inform adherence-oriented policy.
METHODS: A prevalence-based, bottom-up cost-of-illness model was built for each therapeutic area, following Larg and Moss principles and ISPOR Good Practices. The prevalent population was multiplied by published non-adherence rates, excess clinical events from published hazard ratios, and Moroccan unit costs, in 2025 dirham. For chronic kidney disease, avoidable dialysis used a Levin population attributable fraction, combining the relative risk reductions of early nephroprotection reported in pivotal trials. Parameters were graded by evidence tier. Productivity losses followed a human-capital approach.
RESULTS: Across five quantified areas, the annual cost of non-adherence reached approximately 5.2 billion dirham. Hypertension accounted for 385 million dirham, through 9,625 avoidable strokes. Type 2 diabetes accounted for 3.2 billion dirham, combining hospitalisation and productivity loss. Chronic respiratory disease accounted for 990 million dirham, through 198,000 avoidable exacerbations. Chronic kidney disease accounted for 83 to 135 million dirham in the first year, being 534 to 874 avoidable incident dialyses each year, and a cumulative 1.24 to 2.03 billion dirham over five years. A real-world adherence adjustment, where real effectiveness equals trial efficacy multiplied by adherence, reframed non-inferior formulations as superior in routine care.
CONCLUSIONS: Non-adherence imposes a conservative burden near 5.2 billion dirham each year in Morocco, concentrated in cardiometabolic and renal disease. Avoidable dialysis alone represents a multi-billion dirham five-year payer opportunity. Because adherence interventions carry a reported return of three to seven per unit invested, these locally sourced estimates support adherence as a financing priority and a value criterion for reimbursement decisions. Several parameters remain proxy-based, pending Moroccan real-world data.