It is highlighted that poor adherence to asthma and chronic obstructive pulmonary disease (COPD) maintenance therapies negatively impacts health outcomes. Proven and cost-effective programs to promote adherence and persistence are yet to be used widely and regularly. The potential barrier to the uptake of such programs is identified as implementation costs.
A systematic literature review and narrative synthesis of studies have been undertaken to investigate the cost-effectiveness of treatment adherence-maintenance therapies or their impact on the healthcare budget directly or through healthcare resource utilization (HCRU). The search for relevant publications was conducted using MEDLINE and PREMEDLINE (PubMed), EMBASE (Embase.com, Elsevier), and EconLit for publications between January 2000 and July 2021. Clinical trial databases and selected conference proceedings were also included in the search.
Enhancing Maintenance Therapies Adherence and Reducing Healthcare Utilization
From 1,910 potentially relevant articles, 26 met the pre-specified inclusion criteria and underwent data extraction. The extracted data show that 11 articles reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. It is noteworthy that none of these articles included an analysis of biologic medication use.
The interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU – healthcare visits, hospital admissions, and/or the use of medications (including add-on/reliever treatment and antibiotics) – were frequently reported. Improvements in the use of maintenance treatments were noted in some studies. In all cases where favorable outcomes were observed, counseling and/or digitally informed programs were utilized.
In conclusion, adherence-maintenance therapies are mostly cost-effective and often lead to reduced HCRU and associated costs. The greatest benefit appears to come from multidisciplinary care involving one-to-one advice and digitally enhanced communications.
Original Article DOI: 10.1016/j.jaip.2023.12.049
Original title: Cost-effectiveness and impact on healthcare utilization of interventions to improve medication adherence and outcomes in asthma and COPD: A systematic literature review
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