Accounting for Noncompliance in Pharmacoeconomic Evaluations
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Pharmacoeconomics 2001; 19 (12): 1185-1197 1170-7690/01/0012-1185/$22.00/0 —2 © Adis International Limited. All rights reserved.
Accounting for Noncompliance in Pharmacoeconomic Evaluations Dyfrig A. Hughes, Adrian Bagust, Alan Haycox and Tom Walley Prescribing Research Group, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Defining and Measuring Compliance . . . . . . . . . . . . . 1.1 The Various Forms of Noncompliance . . . . . . . . . . 1.2 Measures of Noncompliance . . . . . . . . . . . . . . . 2. Consequences of Noncompliance . . . . . . . . . . . . . . 2.1 Clinical Consequences of Noncompliance . . . . . . . 2.1.1. Types of Noncompliance . . . . . . . . . . . . . 2.1.2 Types of Diseases . . . . . . . . . . . . . . . . . . 2.1.3 Types of Drugs . . . . . . . . . . . . . . . . . . . . 2.2 Economic Consequences of Noncompliance . . . . . 3. Modelling Noncompliance . . . . . . . . . . . . . . . . . . . 3.1 Defining and Measuring Noncompliance . . . . . . . . 3.2 ‘Appropriate’ Levels of Noncompliance . . . . . . . . 3.3 Assumptions Relating to Effectiveness in Noncompliers 3.4 Assumptions Relating to Costs in Noncompliers . . . . 3.5 Modelling Noncompliance: Future Directions . . . . . 4. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Abstract
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Noncompliance with prescribed drug regimens is a widespread phenomenon which results in decreased efficacy and is often associated with increased medical expenditures. Despite this, economic evaluations based on decision-analytic models rarely incorporate noncompliance to allow for the differences in compliance observed between controlled clinical trials and routine clinical practice. This review examines the issues relating to the measurement of noncompliance, and the clinical and economic consequences of noncompliant drug taking behaviour. In order to fully appreciate the clinical (and therefore the economic) consequences of noncompliance, a detailed understanding of the type of noncompliance, the pharmacokinetic and pharmacodynamic properties of the drug and the pathophysiological processes of t
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