The Importance of Integrating Medication Adherence Into Pharmacoeconomic Analyses

The Example of Osteoporosis

Mickaël Hiligsmann; Annelies Boonen; Véronique Rabenda; Jean-Yves Reginster

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(2):159-166. 

In This Article

Abstract and Introduction

Abstract

Adherence to medications is poor and suboptimal in many chronic diseases. Nonadherence can reduce treatment effectiveness and can have an impact on healthcare costs. As a consequence, it may alter the cost–effectiveness of drug therapies. This article emphasizes the importance of integrating medication compliance and persistence into pharmacoeconomic evaluations, using osteoporosis as an example. A limited number of studies carried out to date have suggested important economic implications of poor adherence to osteoporosis medications. Therefore, compliance and persistence should be an integral part of clinical studies and pharmacoeconomic analyses in order to estimate the cost–effectiveness of drug therapies in current community practice. Measuring adherence and incorporating it into health economic modeling may, however, pose particular challenges.

Introduction

Pharmacoeconomic evaluations are increasingly used in healthcare. By comparing costs and consequences of health interventions, economic evaluations can serve as a tool to help decision-makers to efficiently allocate scarce resources. To conduct economic evaluations, researchers often obtain efficacy data from randomized controlled trials (RCTs). Although RCTs have, at least theoretically, high internal validity, they are associated with high levels of adherence compared with those observed in daily practice. The estimates of treatment efficacy and subsequently pharmacoeconomic results may therefore not be generalizable to current community practice. In order to estimate the cost–effectiveness of the intervention/drug in real-life settings, it is important that economic evaluations take adherence into account. Poor compliance and persistence will reduce the cost of the intervention, but at the same time might decrease the side effects and the therapeutic potential of drug therapy in terms of health effects and costs, and can therefore have a substantial impact on the effectiveness and cost–effectiveness of drug therapies.[1]

This study aims to highlight the importance of integrating medication adherence into pharmacoeconomic analyses, using osteoporosis as an example. Poor compliance and persistence are common problems in the treatment of osteoporosis. Approximately 75% of women in whom an oral bisphosphonate – currently the most widely prescribed treatment for osteoporosis – is initiated have been shown to be nonadherent within 1 year and 50% discontinued therapy by this time.[2,3] A few studies carried out to date have suggested important economic implications of poor adherence to osteoporosis medications.[4–8]

More specifically, the purposes of this article are: first, to present and illustrate, by a published example including reviews and single studies, the impacts of poor adherence to osteoporosis medications on effectiveness, healthcare costs and cost–effectiveness; second, to review recent economic evaluations that have integrated compliance and persistence; and last, to discuss some important challenges for incorporating compliance and persistence into pharmacoeconomic analyses conducted in osteoporosis.

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