Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), El Rosario, Spain.
Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain.
Int J Psychiatry Clin Pract. 2020 Nov;24(4):416-427. doi: 10.1080/13651501.2020.1782434. Epub 2020 Jul 1.
Medication non-adherence in mental health problems has social and economic costs. The objective of the study was to review the cost-effectiveness of interventions to enhance medication adherence in patients with mental health problems.
The update of a previous systematic review was performed. Databases were searched in June 2019: MEDLINE, PSYCINFO, EMBASE, CINAHL, CRD, WOS. Cost-effectiveness studies comparing an intervention to improve the medication adherence with other interventions/usual care in adults with mental health problems were included. Data were extracted, methodological quality of the studies was assessed and a narrative synthesis was performed.
Nine studies were included in the review. The interventions that showed medication adherence increase were: a financial incentive when depot injection was taken by patients with psychotic disorders, a value-based benefit design policy including copayment and counselling in a company setting, and a medication treatment decision supported by a pharmacogenetic test. The other studies (coaching by pharmacists; a psychological and educational intervention at health care centres) did not find differences between groups. No study found cost differences between alternatives.
Interventions to improve medication adherence in adults with mental health problems could be cost-effective, especially those based on financial incentives, although more research is needed. KEYPOINTS There are several types of interventions designed to enhance medication adherence in patients with mental health problems. Few of them have demonstrated cost-effectiveness. Two studies found that a financial incentive per depot injection in patients with psychotic disorders improved the medication adherence. Two other studies found improvement in adherence due to two specific interventions: a value-based benefit design policy in a company setting and a pharmacogenetic test supporting the medication treatment decision. No study found differences in costs between the intervention and the comparator. More research is needed to implement cost-effective interventions.
精神健康问题中的药物不依从会产生社会和经济成本。本研究旨在综述提高精神健康问题患者药物依从性的干预措施的成本效益。
对先前的系统综述进行了更新。2019 年 6 月检索了数据库：MEDLINE、PSYCINFO、EMBASE、CINAHL、CRD、WOS。纳入了比较干预措施以提高药物依从性与其他干预措施/常规护理在精神健康问题成人中的成本效益研究。提取数据，评估研究的方法学质量，并进行叙述性综合。
综述纳入了 9 项研究。表明药物依从性增加的干预措施包括：精神障碍患者接受长效注射时给予经济激励、公司环境下采用共付额和咨询的基于价值的获益设计政策、以及药物治疗决策支持药物基因检测。其他研究（药剂师辅导；医疗中心的心理和教育干预）未发现组间差异。没有研究发现替代方案之间的成本差异。
提高精神健康问题成人药物依从性的干预措施可能具有成本效益，特别是基于经济激励的干预措施，但需要更多的研究。
有几种类型的干预措施旨在提高精神健康问题患者的药物依从性。其中很少有研究证明具有成本效益。两项研究发现，精神障碍患者每接受一次长效注射给予经济激励可提高药物依从性。另外两项研究发现，由于两种特定的干预措施（公司环境中的基于价值的获益设计政策和支持药物治疗决策的药物基因检测），依从性得到改善。没有研究发现干预措施与对照之间的成本差异。需要进一步研究以实施具有成本效益的干预措施。
