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When Drugs Don’t Work

Economic Assessment of Enhancing Compliance with Interventions Supported by Electronic Monitoring Devices

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Abstract

Non-compliance with prescribed regimens poses a significant problem in clinical therapeutics — patients who do not take their medications according to the labelling instructions are at higher risk of treatment failure, and this may have adverse effects on health outcome and healthcare costs. There is increasing evidence on strategies aimed at improving compliance, but most studies do not implement an unbiased technique for measuring compliance. Patients and clinicians alike are notoriously unreliable in assessing compliance; the use of electronic compliance-monitoring devices (ECMDs) is one of the most robust ways to identify non-compliance and assess the effectiveness of interventions aimed at promoting compliance. ECMDs may also form a part of the intervention, by allowing the health professional to provide feedback to the patient on his/her dosing history. This approach has been referred to as a ‘measurement-guided medication management (MGMM) programme’.

This article reviews the evidence on the effectiveness of MGMM programmes based on ECMDs, and sets out a framework for assessing their economic value. Existing studies focus primarily on the impact of MGMM programmes on compliance. However, to generalise to other settings, including routine practice, further evidence is required on their clinical and cost effectiveness. Specifically, more studies are required to assess whether the observed improvements in compliance translate to improvements in health outcomes, and whether these may be achieved in a cost-effective manner.

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Notes

  1. The ROC is a graphical plot of the sensitivity versus (1 — specificity) for a binary classifier system (responder/nonresponder) as its discrimination threshold (percentage compliance) is varied.

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Acknowledgements

The author has no conflicts of interest directly relevant to the contents of this paper. No sources of funding were used to assist in the preparation of this work.

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  1. Centre for Economics and Policy in Health, Institute of Medical and Social Care Research, University of Wales, Stryd y Deon, Bangor, Gwynedd, LL57 1UT, Wales, UK

    Dyfrig Hughes

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Hughes, D. When Drugs Don’t Work. Pharmacoeconomics 25, 621–635 (2007). https://doi.org/10.2165/00019053-200725080-00001

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