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The impact of non‐compliance on the cost‐effectiveness of pharmaceuticals: a review of the literature

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  • Dyfrig A. Hughes
  • Adrian Bagust
  • Alan Haycox
  • Tom Walley

Abstract

Non‐compliance with drug therapies not only limits their effectiveness, but in some instances, is associated with grave clinical sequelae and substantial economic burden. It is important, therefore, to consider non‐compliance in economic evaluations. A review of pharmacoeconomic evaluations, which have applied sensitivity analysis to non‐compliance rates, was undertaken to evaluate the impact of non‐compliance on the cost‐effectiveness of different drug therapies. Although 22 evaluations satisfied the inclusion criteria, additional information was obtained from the authors of most studies, as the published details were inadequate. The majority of evaluations assumed altered effectiveness owing to reduced compliance in the absence of supportive clinical evidence. Because of the disparity in the nature of the outcomes, the measures of non‐compliance and the time horizon of the studies evaluated, it was not possible to compare the magnitude of the impact of non‐compliance among different drug–disease combinations. However, it was evident that non‐compliance always results in a reduction in efficacy, but its impact on costs varied substantially. The importance of incorporating measures of compliance is highlighted, as failing to account for ‘real world’ compliance rates in pharmacoeconomic evaluations may lead to selection of sub‐optimal treatment strategies. Copyright © 2001 John Wiley & Sons, Ltd.

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  • 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, October.
  • Handle: RePEc:wly:hlthec:v:10:y:2001:i:7:p:601-615
    DOI: 10.1002/hec.609
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    Cited by:

    1. Domenico Depalo, 2020. "Explaining the causal effect of adherence to medication on cholesterol through the marginal patient," Health Economics, John Wiley & Sons, Ltd., vol. 29(S1), pages 110-126, October.
    2. Afschin Gandjour & Karl Wilhelm Lauterbach, 2005. "How Much Does It Cost to Change the Behavior of Health Professionals? A Mathematical Model and an Application to Academic Detailing," Medical Decision Making, , vol. 25(3), pages 341-347, May.
    3. 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, November.
    4. Katharina E. Blankart & Frank R. Lichtenberg, 2020. "Are patients more adherent to newer drugs?," Health Care Management Science, Springer, vol. 23(4), pages 605-618, December.
    5. Srivastava, Divya & McGuire, Alistair, 2015. "Patient access to health care and medicines across low-income countries," Social Science & Medicine, Elsevier, vol. 133(C), pages 21-27.
    6. Afschin Gandjour & Karl Wilhelm Lauterbach, 2003. "When Is It Worth Introducing a Quality Improvement Program? A Mathematical Model," Medical Decision Making, , vol. 23(6), pages 518-525, November.
    7. Abualbishr Alshreef & Nicholas Latimer & Paul Tappenden & Ruth Wong & Dyfrig Hughes & James Fotheringham & Simon Dixon, 2019. "Statistical Methods for Adjusting Estimates of Treatment Effectiveness for Patient Nonadherence in the Context of Time-to-Event Outcomes and Health Technology Assessment: A Systematic Review of Method," Medical Decision Making, , vol. 39(8), pages 910-925, November.
    8. François-Emery Cotté & Bruno Fautrel & Gérard De Pouvourville, 2009. "A Markov Model Simulation of the Impact of Treatment Persistence in Postmenopausal Osteoporosis," Medical Decision Making, , vol. 29(1), pages 125-139, January.
    9. Rotar, Alexandru M. & Preda, Alin & Löblová, Olga & Benkovic, Vanesa & Zawodnik, Szymon & Gulacsi, Laszlo & Niewada, Maciej & Boncz, Imre & Petrova, Guenka & Dimitrova, Maria & Klazinga, Niek, 2018. "Rationalizing the introduction and use of pharmaceutical products: The role of managed entry agreements in Central and Eastern European countries," Health Policy, Elsevier, vol. 122(3), pages 230-236.
    10. Vincenzo Atella & Federico Belotti & Domenico Depalo, 2017. "Drug therapy adherence and health outcomes in the presence of physician and patient unobserved heterogeneity," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 106-126, September.
    11. Joan Costa‐Font & Rosella Levaggi, 2020. "Innovation, aging, and health care: Unraveling “silver” from “red” herrings?," Health Economics, John Wiley & Sons, Ltd., vol. 29(S1), pages 3-7, October.
    12. Domenico Depalo & Jay Bhattacharya & Vincenzo Atella & Federico Belotti, 2019. "When Technological Advance Meets Physician Learning in Drug Prescribing," NBER Working Papers 26202, National Bureau of Economic Research, Inc.
    13. Hege Urdahl & Andrea Manca & Mark Sculpher, 2006. "Assessing Generalisability in Model-Based Economic Evaluation Studies," PharmacoEconomics, Springer, vol. 24(12), pages 1181-1197, December.
    14. Danielle Brunenberg & Gwenn Wetzels & Patricia Nelemans & Carmen Dirksen & Johan Severens & Henri Stoffers & Jan Schouten & Martin Prins & Peter Leeuw & Manuela Joore, 2007. "Cost Effectiveness of an Adherence-Improving Programme in Hypertensive Patients," PharmacoEconomics, Springer, vol. 25(3), pages 239-251, March.
    15. Robyn Tamblyn & Kristen Reidel & Allen Huang & Laurel Taylor & Nancy Winslade & Gillian Bartlett & Roland Grad & André Jacques & Martin Dawes & Pierre Larochelle & Alain Pinsonneault, 2010. "Increasing the Detection and Response to Adherence Problems with Cardiovascular Medication in Primary Care through Computerized Drug Management Systems: A Randomized Controlled Trial," Medical Decision Making, , vol. 30(2), pages 176-188, March.
    16. Hiligsmann, Mickaël & Rabenda, Véronique & Bruyère, Olivier & Reginster, Jean-Yves, 2010. "The clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients," Health Policy, Elsevier, vol. 96(2), pages 170-177, July.
    17. 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.

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