Multiple Medication Adherence Measurement Working Group
Maria Malmenäs, MSc
Director, Real World Strategy & Analytics
Mapi Group
Stockholm, Sweden
Andrew M. Peterson, PharmD, PhD
Dean, Mayes College of Healthcare Business and Policy
University of the Sciences
Philadelphia, PA, USA
Leadership Group:

Lusine Abrahamyan, MD, MPH, PhD, THETA, Toronto, Canada
Tamás Ágh, MD, MSc, PhD, Principal Researcher, Syreon Research Institute, Budapest, Hungary
Bryan Bennett, Director, Patient-Centered Outcomes, Adelphi Values, Adelphi Mill, UK
Bijan J. Borah, PhD, Professor, Mayo Clinic College of Medicine, Division of Health Care Policy and Research
Rochester, MN, USA
Thomas J. Bunz, Pharm.D., Ph.D, Director of Analytic Strategy, Aetna Consumer Analytics, Hartford, Conn., USA
Mickaël Hiligsmann, PhD, Assistant Professor, Department of Health Services Research of Maastricht University, the Netherlands
David Hutchins, MHSA, MBA, Senior Advisor, Strategic Research, CVS Caremark, USA
Elizabeth Manias, PhD, University of Melbourne, Australia
Priti Pednekar, M.Pharm, B. Pharm, Graduate Student, Mayes College of Healthcare Business and Policy, University of the Sciences, PA, USA
Amit Raval, M.Pharm, PhD, Senior Researcher, Healthcore, Inc., Wilmington, DE, USA
Adina Turcu-Stiolica, PharmD, PhD, Chair of Pharmaceutical Marketing and Management, University of Medicine and Pharmacy Craiova, Romania
Allison F. Williams, RN, PhD, School of Nursing and Midwifery, Monash University, Victoria, Australia
John E. Zeber, PhD, Central Texas Veterans Health Care System, Temple, TX ; Scott & White Healthcare, Center for Applied Health Research, Temple, TX, USA


To summarize, evaluate and compare the existing measurements methods used for calculating medication adherence, regardless of disease area, in patients using poly-pharmacotherapy and recommend good practices for determining medication adherence in patients using multiple drugs.


Medication adherence measurements such as Medication Possession Ratio (MPR) are commonly used to evaluate drugs compliance in a real world setting. Typically, these metrics were developed to measure treatment regimens consisting of a single pharmaceutical agent, mono-pharmacotherapy. Yet, often patients' treatment regimens consist of combination of several medications, poly-pharmacotherapy. Thus, by using the standard adherence measurements, there is a risk of over estimating adherence due to the complexity of handling multiple gap periods. This project's aim is to evaluate and compare the accuracy of existing measurements currently.

  1. Conduct a systematic literature search of methods used calculating medication adherence for multiple drugs
    1. key terms

  2. Evaluate the existing methods, non-regardless of disease area, such as but not limited to
    1. Medication Possession Ratio (MPR)
    2. MPR weighted
    3. Refill rate
    4. Compliance rate
    5. Cumulative multiple refill-interval gap (CMG)
    6. Proportion of Days Covered (PDC)
    7. Others found during the search

  3. Summarizing the methods including disease area usage
  4. Using statistical methods investigate the accuracy of the measurements using an existing patient data set
  5. Conduct a GAP analyses of existing methods
Work Product:

Measuring Multiple Medication Adherence – Which Measure When?

Manuscript to submit to Value in Health: Evaluation of medication adherence measurements in patients using multiple drugs


How Does Measurement of Multiple Medication Adherence Differ Between Chronic Diseases?
May 22, 2017 – ISPOR 22nd Annual International Meeting, Forum Presentation, Boston, MA, USA

Measuring Multiple Medication Aherence – Which Measure When
November 2, 2016 19th Annual European Congress, Workshop Presentation, Vienna, Austria

A Framework for Measuring Adherence to Multiple Medication
October 31, 2016 – 19th Annual European Congress, Podium Presentation, Vienna, Austria

Framework for Measuring Multiple Medication Adherence
May 24, 2016 – 21st International Meeting, Workshop Presentation, Washington, DC, USA

Activity Date
SIG project initiated April 2014
Members solicited to work on project May – July 2014
Meeting at ISPOR 19th Annual International Meeting, Montreal, CA to discuss proposal June 2, 2014
Refine and develop detail outline via TC July – August 2014
Key Terms identified for systematic literature search of  methods used calculating medication adherence for multiple drugs September 2014
Proposal submitted to ISPOR ViH for approval October 2014
Meeting at ISPOR 17th Annual European Congress, Amsterdam to discuss proposal November 10, 2014

Search parameters identified

December 2014

Search initiated

January 2015

Literature Search Reviewed

May 2015 – February 2016

Meeting at ISPOR 20th Annual International Meeting Philadelphia

May 20, 2015

Meet in Milan at 18th Annual European Congress November 10, 2015

Evaluate methods

March – April 2016

Develop manuscript sections 

June – December 2016

Preparation for forum presentation

April 2016

Forum presentation ISPOR 21st Annual International Meeting, USA May 24, 2016

Meet at 21st Annual International Meeting   

May 24, 2016

Forum presentation ISPOR European Congress, Vienna November 2016
Meet at ISPOR European Congress, Vienna November 2016
Draft sections reviewed by leadership group November 2016
Draft finalized December 2016
Draft manuscript sent to ISPOR SIG review group January 2017
Comments reviewed and discussed February 2017

Authors revise sections

February – March 2017

Draft manuscript sent to ISPOR SIG review group

March 2017

Comments reviewed and discussed

April 2017

Authors revise sections April – May 2017
Members and chairs sign finalize on manuscript May 2017

Manuscript submitted to Value in Health

June 2017


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