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Editorial

Bridging the gap: enhancing medication adherence through research and innovation

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Received 19 May 2024, Accepted 05 Jul 2024, Published online: 09 Jul 2024

The issue of medication non-adherence, initially noted by Hippocrates around 400 BC, remains a significant global healthcare challenge [Citation1]. Medication non-adherence affects around 50% of patients with chronic conditions, significantly impacting treatment effectiveness and leading to a substantial increase of healthcare costs, morbidity and mortality rates [Citation2]. In Europe, medication non-adherence is linked to approximately 200,000 deaths annually while in the United States (US), poor adherence is accountable for around 125,000 deaths each year [Citation3,Citation4]. This staggering figure is comparable with the number of deaths caused by colorectal cancer, breast cancer and prostate cancer combined [Citation4]. The annual financial impact of medication non-adherence is estimated between €80B and €125B in Europe and between $100B and $290B in the US [Citation3,Citation5]. Furthermore, with polypharmacotherapy becoming more prevalent as a direct consequence of an aging global population, the need to tackle medication non-adherence has become more urgent [Citation6].

In response, over the past few decades, a variety of technologies and interventions have been developed with the goal of enhancing medication adherence. Starting in the 1990s, various educational and behavioral interventions promoting adherence were introduced and since the 2000s, an increasing number of digital solutions have been developed to improve adherence [Citation1]. These include various technologies such as digital pill dispensers, smart medication packaging, mobile apps, and remote monitoring tools. Despite these advancements, significant gaps in evidence still exist regarding their effectiveness, cost-effectiveness, and access. Consequently, only a handful of these interventions and technologies have been adopted in clinical practice [Citation7]. Additionally, drug delivery systems (DDS), such as single-pill combinations (SPC), have seen improvements, offering promising alternatives to behavioral/educational interventions and digital technologies for enhancing medication adherence [Citation4]. However, the benefits related to improved medication adherence are often overlooked in health technology assessments and pricing decisions, leading to novel DDS frequently being perceived merely as generics compared to originator medicines [Citation8]. This misperception underestimates the unique added value of DDS and reduces the incentives for investing in their innovation, further exacerbating the challenges related to medication adherence.

This special issue of the Expert Review of Pharmacoeconomics & Outcomes Research brings together a series of insightful articles that explore innovative approaches and methodologies designed to enhance medication adherence. Reflecting the latest research, it covers a variety of critical topics, from disease-specific adherence strategies and the integration of cutting-edge technologies to the economic and policy dimensions that influence medication adherence. This thematic issue aims to provide readers with comprehensive insights and practical solutions to advance the field.

1. Disease-specific adherence strategies

This collection includes four literature reviews spanning three disease areas. The review by Al-Aqeel [Citation9] on adherence to antiepileptic medications highlights the varied success of adherence interventions. Despite some positive outcomes in randomized clinical trials, the overall effectiveness of these interventions remains inconsistent, emphasizing the need for targeted, disease-specific strategies. These strategies should assess medication adherence with robust testing and reporting transparency. The review by Duong et al. [Citation10] discusses the unique challenges of adherence in dermatological conditions, particularly with topical treatments. They emphasize the critical role of the provider-patient relationship and suggest strategies to improve adherence in dermatology, including enhancing patient trust, employing behavioral techniques, and utilizing technology to facilitate better communication between patients and healthcare providers. Furthermore, two papers from our collection focus on improving medication adherence in cardiovascular disorders. First, the literature review and meta-analysis by Kengne et al. [Citation11] provide a systematic overview of the effects of SPCs versus free-equivalent combinations in treating hypertension and dyslipidaemia. Their results demonstrate that SPCs not only improve medication adherence but also enhance clinical outcomes (e.g. improved control of systolic blood pressure). Complementing this, another review by Kengne et al. [Citation12] explores the impact of non-pharmacological interventions, such as health education, phone reminders, and digital interventions, on medication adherence in cardiovascular disorders. Their comprehensive analysis of various strategies highlights how non-pharmacological interventions can positively impact adherence and emphasizes the effectiveness of combining educational efforts with modern technology to enhance adherence.

2. Role of technologies in enhancing adherence

The role of technologies in improving adherence is increasingly important, as illustrated in the study by Firlik et al. [Citation13]. The authors introduced a digital platform designed to improve adherence among COPD patients (i.e. the HealthPrize RespiPoints™ program). Their results showed significant improvements in adherence rates among participants, coupled with reduced hospitalizations and overall healthcare costs, illustrating the potential of digital health solutions in chronic disease management. Further elaborating on this topic, the paper by Hosszú et al. [Citation14] discusses a holistic framework for developing and implementing digital medication adherence technologies, emphasizing the importance of engaging medication users at various stages. The engagement of users can ensure that products are not only more effective but also align with real-world needs, thereby enhancing usability and facilitating broad-scale implementation.

3. Economic and policy perspectives on medication adherence

Despite the significant consequences of medication non-adherence, it continues to garner low attention on health policy agendas. Three editorials published in this special issue explore the economic and policy perspectives of medication adherence. The work by Al Meslamani [Citation15] addresses the broader economic and policy dimensions of medication adherence. Another of his papers [Citation16] focuses on the economic impacts of digital endpoints on adherence, suggesting significant cost savings and enhanced healthcare outcomes with the use of digital monitoring tools. Additionally, an editorial by Li [Citation17] advocates for robust governmental policies that support adherence initiatives, including the implementation of legislation, the enhancement of patient education, and the training of healthcare providers, to create an environment conducive to improving medication adherence.

In conclusion, as this special issue illustrates, addressing medication non-adherence requires a multifaceted approach that involves targeted strategies, innovative technologies, and robust policy frameworks. It is imperative that stakeholders from all sectors (i.e. healthcare providers, policymakers, technology developers, pharma industry and patients) collaborate to implement effective solutions that not only enhance medication adherence but also significantly improve health outcomes. By prioritizing and investing in adherence strategies, we can reduce the economic burden of non-adherence and ultimately save lives. The concerted efforts reflected in the articles within this thematic issue underscore the ongoing commitment to transforming the landscape of medication adherence through comprehensive and innovative approaches.

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.

Reviewer disclosures

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

Acknowledgments

The editors express their gratitude to all contributing authors and peer reviewers who made this special issue possible.

Additional information

Funding

This paper was not funded.

References

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