Economic evaluation of interventions to improve medication adherence among patients with chronic diseases: an overview of systematic reviews

ABSTRACT

Introduction

This overview aimed to find, assess, and synthesize systematic reviews that compared the cost-effectiveness of interventions designed to improve medication adherence among patients with chronic disease.

Areas covered

PubMed, Web of Science, Cochrane Database of Systematic Reviews, and Center for Review and Dissemination were searched. The quality of the included reviews was assessed using two validated checklists. The review characteristics and findings were summarized narratively. A total of 9 systematic reviews were included. Interventions reported to be cost-effective were simplification of the medication regimen, financial incentives, improved coverage or reduced out-of-pocket spending, and pharmacist care. The most common interventions were patient education and counseling, with mixed results of cost-effectiveness. This evidence comes from economic evaluations with varying degrees of quality.

Expert opinion

Future evaluations of adherence interventions’ cost-effectiveness will be improved in quality as our understanding of the reasons behind intentional and unintentional nonadherence and factors associated with this behavior advances. The development of criteria for the value assessment of medication adherence-enhancing interventions will contribute to improving the quality of adherence intervention cost-effectiveness research.

KEYWORDS:

• Costs
• cost-benefit analysis
• medication adherence
• systematic review

Article highlights

• This overview identified nine systematic reviews that examined the cost-effectiveness of interventions designed to improve medication adherence among patients with chronic disease.

• The quality of the included reviews, in general, is good, with few areas that can be improved to decrease the risk of bias in their findings.

• Based on the systematic reviews’ findings, simplification of the medication regimen, financial incentives, improved coverage or reduced out-of-pocket spending, and pharmacist care were cost-effective. The most common interventions were patient education and counseling with mixed results of cost-effectiveness.

• This evidence comes from economic evaluations with varying degrees of quality, which precludes robust conclusions on the most cost-effective interventions.

Declaration of interest

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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.