title: Understanding medication compliance and persistence from an economics perspective.
abstract: OBJECTIVE
  An increased understanding of the reasons for noncompliance and lack of persistence with prescribed medication is an important step to improve treatment effectiveness, and thus patient health. Explanations have been attempted from epidemiological, sociological, and psychological perspectives. Economic models (utility maximization, time preferences, health capital, bilateral bargaining, stated preference, and prospect theory) may contribute to the understanding of medication-taking behavior.
  
  
  METHODS
  Economic models are applied to medication noncompliance. Traditional consumer choice models under a budget constraint do apply to medication-taking behavior in that increased prices cause decreased utilization. Nevertheless, empiric evidence suggests that budget constraints are not the only factor affecting consumer choice around medicines. Examination of time preference models suggests that the intuitive association between time preference and medication compliance has not been investigated extensively, and has not been proven empirically. The health capital model has theoretical relevance, but has not been applied to compliance. Bilateral bargaining may present an alternative model to concordance of the patient-prescriber relationship, taking account of game-playing by either party. Nevertheless, there is limited empiric evidence to test its usefulness. Stated preference methods have been applied most extensively to medicines use.
  
  
  RESULTS
  Evidence suggests that patients' preferences are consistently affected by side effects, and that preferences change over time, with age and experience. Prospect theory attempts to explain how new information changes risk perceptions and associated behavior but has not been applied empirically to medication use.
  
  
  CONCLUSIONS
  Economic models of behavior may contribute to the understanding of medication use, but more empiric work is needed to assess their applicability.
authors.affiliation: School of Pharmacy, The University of Nottingham, University Park, Nottingham, UK.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Elliott
authors.forename: Judith A
authors.initials: JA
authors.lastname: Shinogle
authors.forename: Pamela
authors.initials: P
authors.lastname: Peele
authors.forename: Monali
authors.initials: M
authors.lastname: Bhosle
authors.forename: Dyfrig A
authors.initials: DA
authors.lastname: Hughes
mesh_terms: D002017:Budgets; D002755:Choice Behavior; D003657:Decision Making; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D055118:Medication Adherence; D018803:Models, Economic; D017060:Patient Satisfaction; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D012307:Risk Factors; D012959:Socioeconomic Factors
chemical_list: D004364:Pharmaceutical Preparations