Hughes D A, Bagust A, Haycox A, Walley T
Prescribing Research Group, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK.
Pharmacoeconomics. 2001;19(12):1185-97. doi: 10.2165/00019053-200119120-00001.
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 the diseases being treated is required. These are described in detail, and a classification of drug-disease combinations according to the potential economic impact of the varying forms of noncompliance is set out. Issues are raised to highlight the need for improved modelling of the impact of noncompliance, and to this end, recommendations are made for future analyses. The main points are that compliance should be defined clearly, distinguishing between the various forms of noncompliance, that the assumptions relating to the health status of noncompliers should be explicit and robust, and that sensitivity analysis should be applied appropriately to ascertain the impact of noncompliance on the cost-effectiveness of drug therapies.
不遵守规定的药物治疗方案是一种普遍现象，会导致疗效降低，且常常与医疗支出增加相关。尽管如此，基于决策分析模型的经济评估很少纳入不依从性因素，以考虑在对照临床试验和常规临床实践中观察到的依从性差异。本综述探讨了与不依从性测量相关的问题，以及不依从药物服用行为的临床和经济后果。为了充分理解不依从性的临床（进而经济）后果，需要详细了解不依从性的类型、药物的药代动力学和药效学特性以及所治疗疾病的病理生理过程。本文对这些内容进行了详细描述，并根据不同形式不依从性的潜在经济影响对药物 - 疾病组合进行了分类。文中提出了一些问题，以强调改进不依从性影响建模的必要性，并为此提出了未来分析的建议。要点在于应明确界定依从性，区分不同形式的不依从性，与不依从者健康状况相关的假设应清晰且可靠，并且应适当应用敏感性分析来确定不依从性对药物治疗成本效益的影响。
