Open AccessThe economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review
Author(s) -
Muszbek N.,
Brixner D.,
Benedict A.,
Keskinaslan A.,
Khan Z. M.
Publication year - 2008
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/j.1742-1241.2007.01683.x
Subject(s) - medicine , psychological intervention , intensive care medicine , persistence (discontinuity) , disease , cost effectiveness , drug , diabetes mellitus , cost–benefit analysis , economic cost , compliance (psychology) , pharmacology , risk analysis (engineering) , psychiatry , endocrinology , ecology , geotechnical engineering , engineering , biology , psychology , social psychology , neoclassical economics , economics
Summary Objectives: To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost‐effectiveness of pharmaceutical interventions. Methods: English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively. Results: Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non‐drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost‐effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost‐effectiveness ratios, but the extent of this effect was not quantified. Conclusions: Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non‐drug costs, leading to overall cost savings. The effect of noncompliance on the cost‐effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue.