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Inclusion of Compliance and Persistence in Economic Models

Author

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  • Ananth Kadambi
  • Robert Leipold
  • Anuraag Kansal
  • Sonja Sorensen
  • Denis Getsios

Abstract

Economic models are developed to provide decision makers with information related to the real-world effectiveness of therapeutics, screening and diagnostic regimens. Although compliance with these regimens often has a significant impact on real-world clinical outcomes and costs, compliance and persistence have historically been addressed in a relatively superficial fashion in economic models. In this review, we present a discussion of the current state of economic modelling as it relates to the consideration of compliance and persistence. We discuss the challenges associated with the inclusion of compliance and persistence in economic models and provide an in-depth review of recent modelling literature that considers compliance or persistence, including a brief summary of previous reviews on this topic and a survey of published models from 2005 to 2012. We review the recent literature in detail, providing a therapeutic-area-specific discussion of the approaches and conclusions drawn from the inclusion of compliance or persistence in economic models. In virtually all publications, variation of model parameters related to compliance and persistence was shown to have a significant impact on predictions of economic outcomes. Growing recognition of the importance of compliance and persistence in the context of economic evaluations has led to an increasing number of economic models that consider these factors, as well as the use of more sophisticated modelling techniques such as individual simulations that provide an avenue for more rigorous consideration of compliance and persistence than is possible with more traditional methods. However, we note areas of continuing concern cited by previous reviews, including inconsistent definitions, documentation and tenuous assumptions required to estimate the effect of compliance and persistence. Finally, we discuss potential means to surmount these challenges via more focused efforts to collect compliance and persistence data. Copyright Springer International Publishing AG 2012

Suggested Citation

  • Ananth Kadambi & Robert Leipold & Anuraag Kansal & Sonja Sorensen & Denis Getsios, 2012. "Inclusion of Compliance and Persistence in Economic Models," Applied Health Economics and Health Policy, Springer, vol. 10(6), pages 365-379, November.
    • Handle: RePEc:spr:aphecp:v:10:y:2012:i:6:p:365-379
    DOI: 10.1007/BF03261872
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    References listed on IDEAS

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    1. Hiligsmann, Mickaël & Rabenda, Véronique & Bruyère, Olivier & Reginster, Jean-Yves, 2010. "The clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients," Health Policy, Elsevier, vol. 96(2), pages 170-177, July.
    2. François-Emery Cotté & Bruno Fautrel & Gérard De Pouvourville, 2009. "A Markov Model Simulation of the Impact of Treatment Persistence in Postmenopausal Osteoporosis," Medical Decision Making, , vol. 29(1), pages 125-139, January.
    3. Christina M. L. Kelton & Margaret K. Pasquale, 2009. "Evaluating the Claim of Enhanced Persistence: The Case of Osteoporosis and Implications for Payers," Medical Decision Making, , vol. 29(6), pages 690-706, November.
    4. Cleemput, Irina & Kesteloot, Katrien & DeGeest, Sabina, 2002. "A review of the literature on the economics of noncompliance. Room for methodological improvement," Health Policy, Elsevier, vol. 59(1), pages 65-94, January.
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