A model to transfer trial-based pharmacoeconomic analyses to clinical practice.
This article deals with the question of how to handle costs to enhance medication adherence in trial-based pharmacoeconomic analyses. It argues that resources to improve patient adherence have a clearly distinguishable impact on costs and utility and thus are relatively easy to exclude when transferring trial-based pharmacoeconomic analyses to clinical practice. It proposes a model that adjusts trial-based incremental costs and effectiveness for lower medication adherence in clinical practice. It shows that, contrary to conventional wisdom, drug cost effectiveness in clinical practice can be better than in clinical trials. This may have implications for policy recommendations, depending on how close trial-based cost effectiveness is to the maximum willingness to pay. In many situations, the adjustment may not result in a change in policy recommendations.
Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808, USA. afschin.gandjour@pbrc.edu
Afschin
A
Gandjour
D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D006801:Humans; D055118:Medication Adherence; D017059:Models, Econometric; D010818:Practice Patterns, Physicians'
N Engl J Med. 2006 Aug 31;355(9):920-7
16943404
JAMA. 2001 Dec 19;286(23):2988-92
11743840
Am J Psychiatry. 2008 May;165(5):588-96
18413703
JAMA. 2004 Aug 18;292(7):807-20
15315995
Lancet. 2005 Dec 10;366(9502):2005-11
16338449
JAMA. 1998 Jan 21;279(3):222-5
9438743
Med Decis Making. 2008 Jan-Feb;28(1):21-32
18263559
Med Care. 2002 Sep;40(9):794-811
12218770
Med Decis Making. 2009 Mar-Apr;29(2):207-16
19237645
Br J Psychiatry. 2003 Oct;183:323-31
14519610
Depress Anxiety. 2009;26(1):83-97
18833573
Br J Psychiatry. 2001 Mar;178:192-4
11230026
J Clin Psychiatry. 1990 Jun;51 Suppl:60-9; discussion 70-1
2189876
Child Care Health Dev. 2004 Nov;30(6):647-65
15527475
Health Econ. 2001 Oct;10(7):601-15
11747044
Control Clin Trials. 2004 Oct;25(5):447-57
15465615
Med Care. 2005 Jun;43(6):517-20
15908845
Am J Health Syst Pharm. 2003 Apr 1;60(7):657-65
12701547
Med Interface. 1995 Aug;8(8):114-9, 123
10144769
J Clin Psychiatry. 1997 Feb;58(2):47-58
9062373
Value Health. 2007 Nov-Dec;10(6):498-509
17970932
Med Decis Making. 2005 May-Jun;25(3):341-7
15951461
Contemp Clin Trials. 2005 Feb;26(1):59-77
15837453
Med Decis Making. 2003 Nov-Dec;23(6):518-25
14672112