The international generalisability of evidence for health policy: A cross country comparison of medication adherence following policy change

Abstract

The international generalisability of evidence for health policy: a cross country comparison of medication adherence following policy change.Health Policy http://dx.doi.org/10. 1016/j.healthpol.2016.10.009 This is a PDF Þle of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its Þnal form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 1 Title Page TitleThe international generalisability of evidence for health policy: a cross country comparison of medication adherence following policy change Running title Conflicts of InterestSJS and HW have no conflicts of interest. At the time that the study was carried out, JMP received salary support from CVS Caremark for unrelated research on medication adherence. JMF received salary support from CVS Caremark and Merck for unrelated research on medication adherence. 2 KeywordsPharmaceutical policy, Cost sharing, Medication adherence, Generalisability Word count ~3,2003 Highlights  We addressed the question of how generalisable evidence for policy making is across health systems by using a case study of two similar copayment policies in two different health systems and assessing the impact of each policy on adherence.  Two similar copayment policies, in apparently similar health systems, did not invoke similar responses in adherence to medications. Nuanced differences between the health systems and the patients within them may affect differences in impact of policies. Before applying evidence from one health system to the another health system, critical questions of the local applicability of the evidence are key to maximising its' utility. 4 AbstractIntroduction of copayments for prescriptions may increase morbidity and mortality.

Impact of financial burden, resulting from prescription co-payments, on antihypertensive medication adherence in an older publically insured population

“…A meta-analysis identified that good adherence is associated with a 19% reduced risk of cardiovascular disease and a 29% reduction in risk of all-cause mortality [ 10 ]. Analysis of the Irish national primary-care reimbursement database, indicated that the introduction of the co-payment in 2010 was associated with a 4.8% decrease in antihypertensive adherence with similar decreases observed when the co-payment was further increased in January 2013 [ 11 , 12 ]. However, there is socioeconomic variability within the GMS population, as eligibility varies with significantly higher income thresholds applying for older patients (Table 1 ) [ 13 ].…”

Recruiting a representative sample in adherence research—The MALT multisite prospective cohort study experience

“…Notwithstanding this small difference, it is safe to conclude that MALT was able to recruit and maintain a cohort that is fully representative of the national norms for pediatric liver transplant recipients. As we only compared our results to North American data in SPLIT, a limitation of our approach is that our sample, while representative of North American patients, may not be representative of international cohorts; this caveat is important to bear in mind as the behavior of adherence, and its modifiers, is quite different between different nations …”

“…As we only compared our results to North American data in SPLIT, a limitation of our approach is that our sample, while representative of North American patients, may not be representative of international cohorts; this caveat is important to bear in mind as the behavior of adherence, and its modifiers, is quite different between different nations. 18 This achievement is not typical for adherence research, which almost always involves the recruitment of significantly nonrepresentative samples. 19 For example, a recent adherence intervention trial in transplantation medicine reported excellent baseline adherence in the recruited sample (medication possession ratio, MPR, of 0.83.…”

The Perceptions of Patient Copayment on the Reported Adherence to Prescription Medication

“…Such cost-related restriction could be a mechanism for worse health outcomes among low-income and other vulnerable populations who lack adequate insurance coverage (van den Heever, 2012); (Norris et al, 2016). Studies have demonstrated that copayments on medication reduce the consumption of both non-essential and essential medicines, and the latter can lead to worse health outcomes (Strickland & Hanson, 1996); (Sinnott, Buckley, O'Riordan, Bradley, & Whelton, 2013;Sinnott, Whelton, Franklin, & Polinski, 2017). A study conducted in New Zealand showed that patients who did not collect prescription medications due to cost are at increased risk of a subsequent decline in health (Jatrana, Richardson, Norris, & Crampton, 2015).…”

“…A study conducted in New Zealand showed that patients who did not collect prescription medications due to cost are at increased risk of a subsequent decline in health (Jatrana, Richardson, Norris, & Crampton, 2015). Non-compliance to medical regimes is a well-known problem and may lead to an increase in hospital admissions (Atella, Schafheutle, Noyce, & Hassell, 2005;Sinnott et al, 2017) which ultimately results in increased healthcare costs. Adherence to treatment is thus of concern to schemes and prescribers alike.…”