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Abstract
Low patient adherence to health-related interventions is a major barrier to achieving healthcare goals and is associated with very high avoidable costs. Although several studies suggest that adherence-enhancing interventions can improve health outcomes, economic evaluations of these interventions are scarce. Systematic reviews published to date are limited to interventions to enhance adherence to pharmaceuticals or to specific diseases and interventions. The authors’ objective was to examine the evidence regarding the cost-effectiveness of adherence-enhancing interventions in healthcare and what conclusion could be drawn about these interventions. The present systematic review included 43 original studies and assessed the current evidence regarding the cost-effectiveness of a broad array of interventions aimed at enhancing adherence to medications, medical devices, screening tests and lifestyle behaviors. The authors found that although the majority of adherence-enhancing interventions were cost-effective or cost-saving, variation exists within different intervention types. Further research on the sustainability of adherence improvements is needed in order to accurately evaluate interventions’ long-term benefits.
Acknowledgments
The authors would like to thank Teja Thorat from the Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, for her assistance in data collection.
Financial & competing interests disclosure
The study is partially based on data collected for the Tufts Medical Center Cost-Effectiveness Analysis Registry (CEA Registry). The CEA Registry is supported by government, private foundation, and industry sources. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Although adherence-enhancing interventions are associated with improved health outcomes, economic evaluations of these interventions are sparse and there is no integrated analysis of their cost–effectiveness.
Our systematic review included 43 studies of interventions aimed at enhancing adherence to medications, medical devices, screening tests and lifestyle behaviors.
Counseling interventions were mostly cost-effective, yet there was also evidence of interventions of this type that were dominated. These unfavorable results may be attributed to the comparator selected, thus need to be interpreted cautiously.
Interventions that improved insurance coverage were found to be cost-saving or highly cost-effective.
Pharmacist care programs that were targeted at specific conditions were found to be cost-saving or highly cost-effective.
Most interventions that focused on dosing frequency were cost-saving or cost-effective.
Inclusion of cost–effectiveness measures as a standard outcome measure in future research will enable rigorous meta-analyses.
Further research on the sustainability of adherence improvements is needed in order to accurately evaluate intervention’s long-term benefits.