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Patient adherence: a blind spot in cost-effectiveness analyses?
Allison B Rosen1, Alicen B Spaulding, Dan Greenberg
1Departments of Internal Medicine and Health Management and Policy, University of Michigan, 300 N Ingalls, Ste 7E10, Ann Arbor, MI 48109, USA. abrosen@umich.edu
The American Journal of Managed Care
|September 15, 2009
Summary
Few cost-effectiveness analyses (CEAs) model medication adherence, potentially overstating intervention benefits. Future CEAs should incorporate adherence to reflect real-world outcomes.
Area of Science:
- Health Economics
- Pharmacoeconomics
- Clinical Research Methodology
Background:
- Medication adherence significantly impacts cost-effectiveness analysis (CEA) results.
- Previous studies have not fully characterized the inclusion of adherence in published CEAs.
- Excluding adherence may lead to an overestimation of intervention cost-effectiveness.
Purpose of the Study:
- To assess the extent of patient adherence inclusion in CEAs for self-administered medications.
- To investigate if industry sponsorship influences the inclusion of adherence in CEAs.
- To understand the potential bias introduced by excluding adherence in economic evaluations.
Main Methods:
- Systematic review of 177 English-language CEAs of self-administered medications published between 1998 and 2003.
- Independent data abstraction by two trained readers to assess adherence inclusion.
- Statistical analysis using chi-squared tests and logistic regression to identify predictors of adherence inclusion.
Main Results:
- Only 30.5% of CEAs explicitly modeled medication adherence, with half of those including it in both base-case and sensitivity analyses.
- Medication adherence was explicitly modeled in 21% of studies, with limited information on its impact on results.
- Adherence inclusion varied by clinical area, and was not significantly different between industry-sponsored (25.4%) and non-industry-sponsored (35.1%) studies.
Conclusions:
- The modeling of suboptimal medication adherence in CEAs remains infrequent.
- CEAs should explicitly incorporate medication adherence to accurately represent real-world costs and effects.
- Future research should prioritize the inclusion of adherence in economic evaluations of health interventions.
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