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1) "OBJECTIVE: To determine whether the current cost-effectiveness
evidence on adherence-enhancing interventions (AEIs) was of sufficient
quality to aid in decision-making regarding medication adherence
policies. DATA SOURCES: A computerized search of Embase, MEDLINE,
Cinahl, Econlit, NHSEED, Psychlit, EPIC, and Cochrane databases
(1980-April 2004) was performed. English-language human subject
articles were identified using the key words compliance, adherence,
concordance, patient assistance, therapeutic alliance, costs,
economics, efficiency, resource use/utilization, cost-of-illness,
cost-effectiveness, cost-minimization, cost-utility, and cost-benefit.
STUDY SELECTION AND DATA EXTRACTION: Studies that appeared to assess
the cost-effectiveness of medication AEIs were included. Methodologic
rigor was assessed using 15 minimum quality criteria. DATA SYNTHESIS:
We found 45 comparative studies in 43 publications. Asthma (14
studies) and psychiatric illness (12 studies) were most commonly
investigated. In 33 studies, interventions were educational, 18 had
multiple components, and 23 did not appear to be linked to proven
reasons for nonadherence. Reporting of adherence and outcome results
was often unclear. Cost data were poorer quality than outcome data,
using average or estimated costs and omitting some cost elements. Nine
studies carried out incremental economic analysis. No study met all
quality criteria. CONCLUSIONS: We were not able to make definitive
conclusions about the cost-effectiveness of AEIs due to the
heterogeneity of the studies found and incomplete reporting of
results. Important policy decisions need to be made about
nonadherence; however, they are currently being made in a vacuum of
adequate information. AEIs must be based on reasons for nonadherence
and be evaluated using accepted clinical and economic quality
criteria."
2) "We randomized 135 adult asthma patients to a control group, and
132 patients to an experimental group which received a special health
education intervention. Four adherence measures were documented at
baseline and 12-month follow-up: correct inhaler use, inhaler
adherence, medication adherence, and total adherence rating. Costs to
routinely deliver the intervention were $32.03/patient. Experimental
group patients exhibited a significantly higher level of improvement
in adherence (44 percent) than control group patients (2 percent).
3) "BACKGROUND: Comprehensive geriatric assessment (CGA) can be
effective in inpatient units, but such inpatient settings are
prohibitively expensive. If similar benefits could be obtained in
outpatient settings, CGA might be a more attractive option.
OBJECTIVES: To assess the cost-effectiveness (CE) of an outpatient
geriatric assessment with an intervention to increase adherence.
SUBJECTS: Three hundred fifty-one community-dwelling, elderly subjects
with at least one of four geriatric conditions. MEASURES: In addition
to the measures of functioning, we collected data on the costs of the
intervention itself and on the use of medical services in the 64 weeks
after the intervention. RESULTS: The intervention, which prevented
functional decline, cost $273 per participant. The intervention group
averaged three more visits than the control group in the first 32
weeks after the intervention, but only 1.2 extra visits in the next 32
weeks. We estimate that the costs of these additional medical services
would be $473 for the 5 years after the intervention, leading to a
total cost per Quality Adjusted Life Year (QALY) of $10,600.
CONCLUSIONS: The CE of this program compares favorably with many
common medical interventions. Whether investments should be made in
health care resources on treatments that lead to modest improvements
in the functioning of community-dwelling elderly people remains a
societal decision."
4) "PURPOSE: To explore the cost-effectiveness of interventions to
improve adherence to combination antiretroviral therapy in patients
with human immunodeficiency virus (HIV) infection. METHODS: A
simulation model of HIV infection, incorporating CD4 cell count and
HIV ribonucleic acid levels as predictors of disease progression, was
used to estimate the lifetime costs and quality-adjusted life
expectancy associated with clinical interventions to improve adherence
to antiretroviral therapy (e.g., directly observed therapy, automatic
medication dispensers, beepers, portable alarms) in a clinical trial
cohort with early disease (mean CD4 count, 350 cells/microL), a
clinical trial cohort with advanced disease (mean CD4 count, 87
cells/microL), and an urban cohort (mean CD4 count, 217 cells/microL).
Data were from clinical trials, national databases, and published
literature. RESULTS: For relatively healthy patients with early
disease, interventions that reduced virologic failure rates by 10%
increased quality-adjusted life expectancy by 3.2 months, whereas
those that reduced failure by 80% increased quality-adjusted life
expectancy by 34.8 months, as compared with standard care. The
cost-effectiveness ratio was below 50000 US dollars per
quality-adjusted life-year (QALY) for interventions costing 100 US
dollars per month provided that failure rates were reduced by at least
10%, and for those costing 500 US dollars per month provided that
failure rates were reduced by more than 50%. For both patients with
advanced disease and those from an urban cohort, adherence
interventions costing about 500 US dollars per month (e.g., directly
observed therapy) had to reduce failure by about 25% to have
cost-effectiveness ratios below 50000 US dollars per QALY. CONCLUSION:
In patients with lower baseline levels of adherence or advanced
disease, even very expensive, moderately effective adherence
interventions are likely to confer cost-effectiveness benefits that
compare favorably with other interventions."
5) "This report documents the clinical improvements and costs
experienced by a purchaser after introduction of a diabetes disease
management program. A purchaser contracted with American Healthways, a
disease management organization, to initiate a diabetes disease
management program called Diabetes Decisions. Started in 1998, the
program grew to include 662 participants. The results reported are
based on the continuously participating population (12 months of
participation in the program for the reporting year). Participants
were entered into American Healthways' clinical information system and
risk-stratified, and an individualized treatment plan was devised.
Outbound telephone calls by specially trained nurses were a key
intervention. Data were collected on key process measures, financial
parameters, and participant satisfaction. By year 3, there were 422
continuously participating participants. From baseline to the third
year of the program, significant increases in frequency of A1C testing
(21.3% to 82.2%), dilated retinal exams (17.2% to 70.7%), and
performance of foot exams (2.0% to 75.6%) were noted. For 166
participants with five A1C determinations, A1C values dropped from
8.89% to 7.88%. Participants experienced a 36% drop in inpatient
costs. Without adjustment for medical inflation, total medical costs
decreased by 26.8% from the baseline period, dropping to $268.63 per
diabetes participant per month (PDPPM) by year 3, a gross savings of
$98.49 PDPPM. After subtracting the fees paid to Diabetes Decisions, a
net savings of $986,538 was realized. This yielded a return on
investment of 3.37. By investing in a diabetes disease management
program, a purchaser was able to realize significant improvements in
clinical care, substantial cost savings, and a favorable return on
investment."
6) "BACKGROUND: Non-compliance rates with antipsychotic medication can
be high, and the personal and societal costs are considerable. A new
psychological intervention, compliance therapy seeks to improve
compliance and patient outcomes and reduce treatment costs. METHOD: A
randomised controlled study examined the cost-effectiveness of
compliance therapy compared to non-specific counselling over 18 months
for 74 people with psychosis admitted as inpatients at the Maudsley
Hospital. Bivariate and multivariate analyses were conducted to test
for differences and to explore inter-patient cost variations. RESULTS:
Compliance therapy is more effective and is no more expensive.
Consequently, compliance therapy is more cost-effective than
non-specific counselling at six, 12 and 18 months. CONCLUSIONS: There
are compliance, outcome and cost-effectiveness arguments in favour of
compliance therapy in preference to non-specific counselling."
7) "OBJECTIVE: Tailored telephone counseling and physician-based and
clinic-based interventions have been shown to be cost-effective in
enhancing utilization of mammography among nonadherent women. The
objective of this study was to evaluate the costs and benefits of a
broad implementation of these interventions from a health payer
perspective. METHODS: CAN*TROL computer modeling was employed in the
cost-effectiveness analysis of interventions in a 2000 Texas female
population. The estimated effects of the various interventions and
their related costs derived from the literature were applied to a
hypothetical scenario of a broad implementation of these
interventions. RESULTS: Seven studies were identified from the
literature, six of them employed tailored telephone counseling (TC),
whereas two used comprehensive physician-based (PB) or clinic-based
(CB) interventions. The estimated intervention cost per women was 43
dollars for TC, 71 dollars for PB, and 151 dollars for CB. CAN*TROL
model showed that after 15 years of implementation, TC, PB, and CB
could reduce cancer mortality by 6.5, 2.2, and 10.7%, respectively.
The cumulative net costs of interventions, mammography screening, and
medical care costs were lower for TC (TC vs. PB vs. CB, 1.05 million
vs. 1.06 million vs. 1.60 million). Nevertheless, CB resulted in more
life-years saved (TC vs. PB vs. CB, 11,413 vs. 8515 vs. 14,559). The
incremental cost-effectiveness ratio was more favorable for tailored
telephone counseling interventions. One-way sensitivity analysis
indicated that compliance rates and intervention costs had the most
significant impact on the incremental cost-effectiveness ratio.
CONCLUSION: Tailored telephone counseling interventions may be the
preferred first-line intervention for getting nonadherent women aged
50 to 79 years on schedule for mammography screening."
8) "OBJECTIVE: To determine whether the current cost-effectiveness
evidence on adherence-enhancing interventions (AEIs) was of sufficient
quality to aid in decision-making regarding medication adherence
policies. DATA SOURCES: A computerized search of Embase, MEDLINE,
Cinahl, Econlit, NHSEED, Psychlit, EPIC, and Cochrane databases
(1980-April 2004) was performed. English-language human subject
articles were identified using the key words compliance, adherence,
concordance, patient assistance, therapeutic alliance, costs,
economics, efficiency, resource use/utilization, cost-of-illness,
cost-effectiveness, cost-minimization, cost-utility, and cost-benefit.
STUDY SELECTION AND DATA EXTRACTION: Studies that appeared to assess
the cost-effectiveness of medication AEIs were included. Methodologic
rigor was assessed using 15 minimum quality criteria. DATA SYNTHESIS:
We found 45 comparative studies in 43 publications. Asthma (14
studies) and psychiatric illness (12 studies) were most commonly
investigated. In 33 studies, interventions were educational, 18 had
multiple components, and 23 did not appear to be linked to proven
reasons for nonadherence. Reporting of adherence and outcome results
was often unclear. Cost data were poorer quality than outcome data,
using average or estimated costs and omitting some cost elements. Nine
studies carried out incremental economic analysis. No study met all
quality criteria. CONCLUSIONS: We were not able to make definitive
conclusions about the cost-effectiveness of AEIs due to the
heterogeneity of the studies found and incomplete reporting of
results. Important policy decisions need to be made about
nonadherence; however, they are currently being made in a vacuum of
adequate information. AEIs must be based on reasons for nonadherence
and be evaluated using accepted clinical and economic quality
criteria."
9) "Public health educational campaigns can attract large numbers of
one-time participants, but the impact on subsequent behavior remains
unstudied. The American Cancer Society Texas Division, Inc. sponsored
a statewide $50.00 mammography screening project in early 1987. More
than 64,000 mammograms were completed at 306 centers; 37,000 screenees
answered a 31-item questionnaire. Attitudes toward screening were
assessed, and screening history was recorded. Eighteen months after
the project, a follow-up questionnaire was sent to 1000 screenees; 411
women returned the questionnaires. In the year following the project,
51% of the women 50 years and older reported having a subsequent
mammogram. Among the women in this group who had never had a mammogram
prior to 1987, 42% had screening mammography repeated in the following
year. These data show that media-based public education projects can
be effective mechanisms for improving and maintaining compliance with
mammography screening recommendations." |
