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Published on: January 8, 2020
Methods for integrating medication compliance and persistence in pharmacoeconomic evaluations
Dyfrig Hughes1, Warren Cowell, Tamas Koncz
1Institute of Medical and Social Care Research, University of Wales, Bangor, Gwynedd, Wales, UK. d.a.hughes@bangor.ac.uk
Summary
Integrating patient compliance and persistence into economic evaluations is crucial for accurate cost-effectiveness analysis. Current methods often lack detail and consistency, highlighting a need for standardized approaches in pharmacoeconomic research.
Area of Science:
- Health Economics
- Pharmacoeconomics
- Health Services Research
Background:
- Suboptimal patient compliance and nonpersistence with drug treatments significantly impact therapeutic outcomes and incur economic costs.
- These factors are critical determinants of therapeutic nonresponse, affecting overall healthcare expenditure and treatment efficacy.
Purpose of the Study:
- To describe appropriate methodologies for integrating noncompliance and nonpersistence into economic evaluations.
- To review and appraise existing methods used in pharmacoeconomic studies concerning compliance and persistence.
Main Methods:
- A systematic literature search of MEDLINE and NHS-EED for economic evaluations published between 1997 and 2005.
- Inclusion criteria focused on studies exploring the impact of compliance-related measures on cost-effectiveness results.
- Critical appraisal of methodologies, including Markov models, decision analyses, net-benefit regression, and discrete event simulations.
Main Results:
- Ten articles were selected, but most lacked detail on compliance assessment and its impact on health outcomes.
- Markov models and decision analyses were commonly used; Markov models directly incorporate persistence.
- Net-benefit regression is suitable for patient-level data, while discrete event simulations offer greater flexibility.
Conclusions:
- Compliance and persistence are not routinely incorporated into pharmacoeconomic analyses despite their significant potential impact.
- Existing analyses often suffer from a lack of methodological rigor and inconsistent definitions, limiting their utility.
- The discussed analytical techniques should inform the development of guidelines for appropriate methodology in pharmacoeconomic evaluations.
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