Cost Effectiveness of Medication Adherence-Enhancing Interventions: A Systematic Review of Trial-Based Economic Evaluations

Oberjé, E.; Kinderen, Reina J.A. de; Evers, Silvia M. A. A.; Woerkum, C.M.J. van; Bruin, Marijn de

doi:10.1007/s40273-013-0108-8

Cited by 39 publications

(31 citation statements)

References 46 publications

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“…An important reason for poor asthma control and, consequently, increased healthcare expenditure is suboptimal adherence to the prescribed regimen [5][6][7]. To date, few adherence interventions evaluated in asthma treatment have been found to be (cost-)effective [8][9][10]. A systematic review of observational evidence on adherence determinants could help identify the patients most at-risk for nonadherence and the key drivers of nonadherence that can be modified in adherence interventions.…”

Section: Introductionmentioning

confidence: 99%

Asthma inhaler adherence determinants in adults: systematic review of observational data

et al. 2014

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Nonadherence to inhaled medication leads to poor asthma control and increased healthcare utilisation. Many studies exploring adherence determinants have been conducted, but summaries of the evidence are scarce. We performed a systematic review of observational research on determinants of asthma inhaler adherence among adults.We searched for articles in English reporting quantitative observational studies on inhaler adherence correlates among adults in developed countries, published in EMBASE, Medline, PsychInfo and PsychArticles in 1990-2014. Two coders independently assessed eligibility and extracted data, and assessed study quality. Results were summarised qualitatively into social and economic, and healthcare-, therapy-, condition-and patient-related factors.The 51 studies included mainly examined patient-related factors and found consistent links between adherence and stronger inhaler-necessity beliefs, and possibly older age. There was limited evidence on the relevance of other determinants, partly due to study heterogeneity regarding the types of determinants examined. Methodological quality varied considerably and studies performed generally poorly on their definitions of variables and measures, risk of bias, sample size and data analysis.A broader adoption of common methodological standards and health behaviour theories is needed before cumulative science on the determinants of adherence to asthma inhalers among adults can develop further. @ERSpublications Major opportunities for strengthening evidence on determinants of nonadherence to asthma inhalers: methods and theory

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Section: Introductionmentioning

confidence: 99%

Asthma inhaler adherence determinants in adults: systematic review of observational data

et al. 2014

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“…Systematic reviews suggest that many health behaviour change (HBC) trials suffer from a moderate to high risk of bias (e.g. Oberjé, de Kinderen, Evers, van Woerkum, & de Bruin, 2013;Poobalan, Aucott, Precious, Crombie, & Smith, 2009); more so than, for example, drug trials (Crocetti, Amin, & Scherer, 2010). Moreover, risk-of-bias scores have been found to explain heterogeneity in effect sizes, especially in trials with subjective outcome measures (Savovic et al, 2012;Wood et al, 2008).…”

Section: Editorialmentioning

confidence: 99%

Risk of bias in randomised controlled trials of health behaviour change interventions: Evidence, practices and challenges

Bruin¹

2014

Psychology & Health

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“…This study is the first economic evaluation of any adherence-enhancing intervention in epilepsy, and has strengths in that it utilitises patient-level data from randomised controlled trials and addresses many of the methodological limitations of comparable evaluations in other clinical contexts [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…Given that interventions to improve adherence require utilisation of healthcare resources, and that the case for the cost-effectiveness of adherence-enhancing interventions in general has not been made [16,17], we aimed to estimate the cost-effectiveness of the most plausibly effective…”

Section: Introductionmentioning

confidence: 99%

Economic evaluation of a behavior-modifying intervention to enhance antiepileptic drug adherence

Plumpton

Brown

Reuber

et al. 2015

Epilepsy & Behavior

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Between 35% and 50% of patients with epilepsy are reported not to be fully adherent to their medication schedule. We aimed to conduct an economic evaluation of strategies for improving adherence to antiepileptic drugs. Based on the findings of a systematic review, we identified an implementation-intention intervention (specifying when, where and how to act) which was tested in a trial that closely resembled current clinical management of patients with epilepsy, and which measured adherence with an objective and least biased method. Using patient-level data, trial patients were matched to those recruited to the Standard And New Antiepileptic Drugs trial, according to their clinical characteristics and adherence. Generalised linear models were used to adjust cost and utility in order to estimate the incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the National Health Service in the UK. The mean cost of the intervention group, £1,340 (95% CI £1,132, £1,688) was marginally lower than that of the control group representing standard care £1,352 (95% CI £1,132, £1,727). QALYs in the intervention group were higher than the control, 0.75 (95% CI 0.70, 0.79), compared with 0.74 (95% CI 0.68, 0.79), U"T that the intervention is cost effective at a threshold of £20,000 per QALY is 94%. Our analysis lends support to the cost-effectiveness of a self-directed, implementation-intention intervention for improving adherence to antiepileptic drugs. However, as with any modeling dependent on limited data on efficacy, there is considerable uncertainty surrounding the clinical effectiveness of the intervention which would require a substantive trial for a more definitive conclusion.

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Cost Effectiveness of Medication Adherence-Enhancing Interventions: A Systematic Review of Trial-Based Economic Evaluations

Cited by 39 publications

References 46 publications

Asthma inhaler adherence determinants in adults: systematic review of observational data

Asthma inhaler adherence determinants in adults: systematic review of observational data

Risk of bias in randomised controlled trials of health behaviour change interventions: Evidence, practices and challenges

Economic evaluation of a behavior-modifying intervention to enhance antiepileptic drug adherence

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