Cost Effectiveness of Medication Adherence-Enhancing Interventions: A Systematic Review of Trial-Based Economic Evaluations
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In light of the pressure to reduce unnecessary healthcare expenditure in the current economic climate, a systematic review that assesses evidence of cost effectiveness of adherence-enhancing interventions would be timely.
Our objective was to examine the cost effectiveness of adherence-enhancing interventions compared with care as usual in randomised controlled trials, and to assess the methodological quality of economic evaluations.
MEDLINE, PsycInfo, EconLit and the Centre for Reviews and Dissemination databases were searched for randomised controlled trials reporting full economic evaluations of adherence-enhancing interventions (published up to June 2013). Information was collected on study characteristics, cost effectiveness of treatment alternatives, and methodological quality.
A total of 14 randomised controlled trials were included. The quality of economic evaluations and the risk of bias varied considerably between trials. Four studies showed incremental cost-effectiveness ratios (ICERs) below the willingness-to-pay threshold. Few studies seemed to evaluate interventions that successfully changed adherence.
Only 14 randomised controlled trials examined the cost effectiveness of adherence interventions. Despite that some studies showe favourable ICERs, the overall quality of studies was modest and the economic perspectives applied were frequently narrow. To demonstrate that adherence interventions can be cost effective, we recommend that proven-effective adherence programmes are subjected to comprehensive economic evaluations.
KeywordsCost Effectiveness Economic Evaluation Usual Care Uncertainty Analysis Adherence Intervention
This study was funded by ZonMw (the Netherlands), programme Doelmatigheidsonderzoek (grant number 171002208). This funding source had no role in study design, data collection, analysis, interpretation or writing of the report.
Conflicts of interest
All authors (EO, RdK, CvW, SE and MdB) declare that they have no competing interests.
EO had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: EO, MdB, SE and CvW. Acquisition of data: EO. Analysis and interpretation of data: EO, RdK and MdB. Drafting of the manuscript: EO and MdB. Critical revision of the manuscript for important intellectual content: EO, MdB, SE, RdK and CvW. Obtained funding: MdB.
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