Avoiding research waste through cost-effectiveness analysis: the example of medication adherence-enhancing interventions

Abstract

Cost-effectiveness analysis (CEA) in health care has two important goals. One is to inform current funding decisions and the other is to inform future research. In the current literature, however, the first goal seems to play a much larger role than the second. The purpose of this note is to show, using the example of medication adherence-enhancing interventions, that CEA can play an important role in informing future clinical trials. In this example incremental cost-effectiveness ratios of drug treatment larger than zero generally prohibit the conduct of clinical trials on the efficacy/effectiveness of adherence-enhancing interventions. Current evidence suggests, however, that CEAs on drug treatment are rarely conducted before running such trials.

Keywords:

• clinical trial
• cost-effectiveness analysis
• health care
• medication adherence
• research

Financial & competing interests disclosure

The author has 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• While one reason to conduct cost-effectiveness analysis (CEA) is to inform current funding decisions, the other reason is to inform future research.

• The purpose of this note is to show that CEAs on drug treatment are particularly useful to inform future trials on the efficacy/effectiveness of adherence-enhancing interventions.

• The underlying reasoning is that payers are not willing to spend additional resources on changing the behavior of patients when behavior can be controlled by the individual and is not life-threatening.

• Hence, incremental cost-effectiveness ratios of drug treatment larger than zero generally prohibit the conduct of clinical trials on the efficacy/effectiveness of adherence-enhancing interventions.

• Current evidence suggests, however, that CEAs on drug treatment are rarely conducted before running such trials.