Economic impact of medication non-adherence

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𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Medication non-adherence is a global issue of major public health concern highlighted by the causal link between non-adherence, increased disease prevalence and health care resource use. Cost assessment of the economic burden lacks uniformity and consistency in determination. The use of a standardised methodology to determine the cost associated with medication non-adherence is required to facilitate international comparisons and demonstrate a reliable estimate of the magnitude of the problem on a global scale. 𝗢𝗯𝗷𝗲𝗰𝘁𝗶𝘃𝗲𝘀: To explore, analyse and estimate the economic impact of medication non-adherence. The research aimed to conceptualise and define a cost estimation framework to streamline the cost outcome indicators that are employed to evaluate the monetary burden linked to non-adherence. Additionally, a monetary estimate of the medication non-adherence burden in Australia was quantified whilst simultaneously exploring the potential role community pharmacists play in reducing the associated burden. 𝗠𝗲𝘁𝗵𝗼𝗱𝗼𝗹𝗼𝗴𝘆: A series of discrete studies were undertaken: (1) a systematic review of studies assessing the economic impact of medication non-adherence across disease groups; (2) development of a medication adherence cost estimation (MACE) framework through secondary analysis of the systematic review data; and (3) analysis of a large database of patient dispensing records appraising the cost of medication non-adherence in Australia and the cost saving effect community pharmacist led intervention had on adherence. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: The systematic review identified wide scoping cost variations reported across 79 studies, with lower levels of adherence associated with higher health care costs. Annual adjusted disease specific economic cost of non-adherence per person ranged from USD2015 $949- $44190 (chapter 3). Collation of outcomes resulted in the development of the MACE framework through identification of two core cost outcome indicators (direct and indirect costs), seven subcategories (hospital, primary care, medical test, pharmacy, direct non-medical, societal and productivity costs) and 35 cost outcome indicator examples. The most utilised cost categories were hospital (68%, n=54), primary care (18%, n=15) and pharmacy costs (72%, n=57) (chapter 4). The national cost of medication non-adherence in Australia across hypertension, dyslipidaemia and depression was AUD2018 $10.4 billion. Community pharmacist led intervention was estimated to save the Australian health care system AUD2018 $1.9 billion annually. Application of the MACE framework post pharmacist intervention highlighted the greatest cost contributors to be associated with direct costs, particularly, outpatient expenses $2.1 billion, inpatient admissions $1.9 billion, prescription medications $1.8 billion and medical related expenses $1.6 billion (chapter 5). 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: Medication non-adherence is a costly burden placing financial drain on health care systems that has failed to be adequately prioritised by governments and health care organisations within national policy. The incorporated framework has been proposed to homogenise international measures and applied to the Australian landscape to demonstrate the scope of the problem and highlight the potential role of community pharmacists moving forward to counteract the rising economic encumbrance. The MACE framework facilitates the strengthening of adherence research and provides a strong foundation for evidence based costing studies to be incorporated into economic evaluations to aid decision making. Decision makers should seek to utilise pharmacists as an integrated member of the health care team to help curb the rising burden of medication non-adherence and generate cost savings to the health care system.
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