Therapeutic non adherence: a rational behavior revealing patient preferences ?
AbstractThis paper offers an indirect measure of patient welfare based on whether patients comply with the prescription they receive. Adherence behavior is supposed to reveal patients' subjective valuations of particular therapies. We write a simple theoretical model of patient adherence behavior, that reflects the trade-off between perceived costs and observed regimen efficacy. A discrete choice framework is then used for the estimation, ie the comparison of the incremental benefit of drug intake between two regimens. Consequently, the empirical analysis is based on the identification of patient and drug characteristics associated with adherence. The econometric approach is implemented through a bivariate panel two-equation simultaneous system studying jointly the factors associated with adherence and response to treatment. The data come from a randomized clinical trial conducted in France between 1999 and 2001 and comparing the efficacy of 2 tritherapy strategies in HIV disease. Both the theoretical and empirical results suggest that, for comparable clinical efficacy and toxicity levels, a higher adherence level is associated with higher patient welfare, thus adding valuable information to conclusions drawn by a mere biostatistical analysis. Therefore, from the perspective of the patient, the adherence-enhancing drug must be favored. Our results based on panel data also stress that unobserved patient characteristics account substantially for drug valuation and that the assessment evolves during the course of the treatment. Furthermore, we provide a new framework for the analysis of adherence data. The microeconometric framework highlights that non adherence is an endogenous behavior, thus suggesting new ways for improving adherence.
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Date of creation: Nov 2006
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drug valuation method ; revealed preferences ; endogenous adherence behavior ; panel bivariate probit estimation ; HIV;
Other versions of this item:
- Karine Lamiraud & Pierre-Yves Geoffard, 2007. "Therapeutic non-adherence: a rational behavior revealing patient preferences?," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1185-1204.
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Clarke, Philip M., 1998. "Cost-benefit analysis and mammographic screening: a travel cost approach," Journal of Health Economics, Elsevier, vol. 17(6), pages 767-787, December.
- Sickles, Robin C & Taubman, Paul, 1986.
"An Analysis of the Health and Retirement Status of the Elderly,"
Econometric Society, vol. 54(6), pages 1339-56, November.
- Robin C. Sickles & Paul J. Taubman, 1984. "An Analysis of the Health and Retirement Status of the Elderly," NBER Working Papers 1459, National Bureau of Economic Research, Inc.
- Conrad, Peter, 1985. "The meaning of medications: Another look at compliance," Social Science & Medicine, Elsevier, vol. 20(1), pages 29-37, January.
- E.K. Berndt & B.H. Hall & R.E. Hall, 1974. "Estimation and Inference in Nonlinear Structural Models," NBER Chapters, in: Annals of Economic and Social Measurement, Volume 3, number 4, pages 103-116 National Bureau of Economic Research, Inc.
- Guilkey, David K. & Murphy, James L., 1993. "Estimation and testing in the random effects probit model," Journal of Econometrics, Elsevier, vol. 59(3), pages 301-317, October.
- Paul Ellickson & Scott Stern & Manuel Trajtenberg, 2001.
"Patient Welfare and Patient Compliance -- An Empirical Framework for Measuring the Benefits from Pharmaceutical Innovation,"
in: Medical Care Output and Productivity, pages 539-564
National Bureau of Economic Research, Inc.
- Paul Ellickson & Scott Stern & Manuel Trajtenberg, 1999. "Patient Welfare and Patient Compliance: An Empirical Framework for Measuring the Benefits from Pharmaceutical Innovation," NBER Working Papers 6890, National Bureau of Economic Research, Inc.
- Mundlak, Yair, 1978. "On the Pooling of Time Series and Cross Section Data," Econometrica, Econometric Society, vol. 46(1), pages 69-85, January.
- Bresnahan, Timothy F, 1986. "Measuring the Spillovers from Technical Advance: Mainframe Computers inFinancial Services," American Economic Review, American Economic Association, vol. 76(4), pages 742-55, September.
- Johansson, Per-Olov, 1997. "On the use of market prices to evaluate medical treatments," Journal of Health Economics, Elsevier, vol. 16(5), pages 609-615, October.
- Cleemput, Irina & Kesteloot, Katrien & DeGeest, Sabina, 2002. "A review of the literature on the economics of noncompliance. Room for methodological improvement," Health Policy, Elsevier, vol. 59(1), pages 65-94, January.
- Timothy F. Bresnahan & Robert J. Gordon, 1996. "The Economics of New Goods," NBER Books, National Bureau of Economic Research, Inc, number bres96-1, May.
- Tomas Philipson & Larry V. Hedges, 1998. "Subject Evaluation in Social Experiments," Econometrica, Econometric Society, vol. 66(2), pages 381-408, March.
- Dyfrig A. Hughes & Adrian Bagust & Alan Haycox & Tom Walley, 2001. "The impact of non-compliance on the cost-effectiveness of pharmaceuticals: a review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 10(7), pages 601-615.
- Mealem, Yosef & Siniver, Erez & Yaniv, Gideon, 2012. "Patient compliance, physician empathy and financial incentives within a principal-agent framework," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 41(6), pages 827-830.
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