Economic impact of medication non-adherence by disease groups: a systematic review

Abstract

Objective: To determine the economic impact of medication non-adherence across multiple disease groups.

Design: Systematic review.

Evidence review: A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist.

Results: Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to 'all causes' non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents.

Conclusion: Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required.

Prospero registration number: CRD42015027338.

Keywords: adherence; health economics; health policy; public health; quality in health care.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. The PRISMA diagram details the search and selection process applied during the overview. The search yielded a total of 2768 citations. Studies were selected based on the inclusion criteria; studies reporting the cost of medication non-adherence using original cost data. Intervention studies were required to report baseline data. Seventy-nine original studies met the inclusion criteria.

Figure 2

Annual adjusted medication non-adherence costs per patient per year. Encompasses the minimum, maximum and IQR of adjusted annual costs incurred by patients across disease groups where three or more studies were included for review. Gastrointestinal only included three studies limiting the range of costs. All-cause costs encompass non-adherence costs incurred in mixed disease state studies, taking into account other confounding factors such as comorbidities.

Figure 3

Annual unadjusted medication non-adherence costs per patient per year. Encompasses the minimum, maximum and IQR of unadjusted annual costs incurred by patients across disease groups where three or more studies were included for review. Epilepsy and addiction only included three studies limiting the range of costs. All-cause costs encompass non-adherence costs incurred in mixed disease state studies, taking into account other confounding factors such as comorbidities.