Muszbek N, Brixner D, Benedict A, Keskinaslan A, Khan Z M
United BioSource Corporation, London, UK.
Int J Clin Pract. 2008 Feb;62(2):338-51. doi: 10.1111/j.1742-1241.2007.01683.x.
To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions.
English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively.
Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified.
Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue.
回顾自1995年以来发表的关于心血管疾病（CVD）及相关病症（高血压、血脂异常、糖尿病和心力衰竭）的依从性和/或持续性的成本后果的研究，并评估不依从对医疗保健支出和药物干预成本效益的影响。
通过数据库检索，确定1995年1月至2007年2月期间发表的英文论文，这些论文研究了CVD或相关病症药物治疗的依从性/持续性，对药物干预进行了经济评估或成本分析，并量化了不依从的成本后果。对各研究中不依从的成本后果进行描述性比较。
在确定的23项研究中，10项聚焦于高血压，7项聚焦于糖尿病，1项聚焦于血脂异常，1项聚焦于冠心病，1项聚焦于心力衰竭，3项涵盖多种疾病。在仅评估药物成本的研究中，依从性/持续性增加导致药物成本增加。然而，依从性/持续性增加提高了治疗效果，导致医疗事件和非药物成本减少。这抵消了较高的药物成本，从而节省了总体治疗成本。在评估依从性/持续性对药物干预成本效益影响的研究中，依从性/持续性增加似乎降低了成本效益比，但这种影响的程度未被量化。
心血管疾病和抗糖尿病药物的不依从是一个重大问题。依从性/持续性增加会导致药物成本增加，但这些增加被非药物成本的减少所抵消，从而带来总体成本节约。不依从对药物干预成本效益的影响尚无定论，需要进一步研究来解决这一问题。
