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J Med Econ. 2019 Jun;22(6):554-566. doi: 10.1080/13696998.2019.1572014. Epub 2019 Feb 4.

Incorporating adherence in cost-effectiveness analyses of asthma: a systematic review.

Author information

1
a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand.
2
b School of Pharmacy , Monash University Malaysia , Jalan Lagoon Selatan , Selangor Darul Ehsan , Malaysia.
3
c Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster , Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia , Jalan Lagoon Selatan , Selangor Darul Ehsan , Malaysia.
4
d School of Pharmacy , University of Wisconsin-Madison , Madison , WI , USA.

Abstract

Aims: Non-adherence is associated with poor clinical outcomes among patients with asthma. While cost-effectiveness analysis (CEA) is increasingly used to inform value assessment of the interventions, most do not take into account adherence in the analyses. This study aims to: (1) Understand the extent of studies considering adherence as part of the economic analyses, and (2) summarize the methods of incorporating adherence in the economic models. Materials and methods: A literature search was performed from the inception to February 2018 using four databases: PubMed, EMBASE, NHS EED, and the Tufts CEA registry. Decision model-based CEA of asthma were identified. Outcomes of interest were the number of studies incorporating adherence in the economic models, and the incorporating methods. All data were extracted using a standardized data collection form. Results: From 1,587 articles, 23 studies were decision model-based CEA of asthma, of which four CEA (17.4%) incorporated adherence in the analyses. Only the method of incorporating adherence by adjusting treatment effectiveness according to adherence levels was demonstrated in this review. Two approaches were used to derive the associations between adherence and effectiveness. The first approach was to apply a mathematical formula, developed by an expert panel, and the second was to extrapolate the associations from previous published studies. The adherence-adjusted effectiveness was then incorporated in the economic models. Conclusions: A very low number of CEA of asthma incorporated adherence in the analyses. All the CEA adjusted treatment effectiveness according to adherence levels, applied to the economic models.

KEYWORDS:

Asthma; I00; I18; adherence; cost-effectiveness; economic evaluation; systematic review

PMID:
30663455
DOI:
10.1080/13696998.2019.1572014
[Indexed for MEDLINE]

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