Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala, Lumpur, Malaysia.
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia.
J Asthma. 2022 Apr;59(4):697-711. doi: 10.1080/02770903.2021.1875483. Epub 2021 Feb 8.
This systematic review aimed to evaluate the cost-effectiveness of medication adherence-improving interventions in patients with asthma. Search engines including PubMed, Scopus and EBSCOhost were used to locate relevant studies from the inception of the databases to 19 October 2018. Drummond's checklist was used to appraise the quality of the economic evaluation. Economic studies evaluating the cost-effectiveness of medication adherence enhancing interventions for asthmatic patients were selected. Relevant information including study characteristics, quality assessment, health outcomes and costs of intervention were narratively summarized. The primary outcome of interest was cost-effectiveness (CE) values and the secondary outcomes were costs, medication adherence and clinical consequences. Twenty studies including 11 randomized controlled trials, 6 comparative studies and 3 modeled studies using Markov models were included in the review. Among these, 15 studies evaluated an educational intervention with 13 showing cost-effectiveness in improving health outcomes. The CE of an internet-based intervention showed similar results between groups, while 3 studies of simplified drug regimens and adding a technology-based training program achieved the desirable cost-effectiveness outcome. Overall, our results would support that all of the identified medication adherence-enhancing interventions were cost-effective considering the increased adherence rate, improved clinical effectiveness and the reduced costs of asthma care. However, it was not possible to identify the most cost-effective intervention. More economic studies with sound methodological conduct will be needed to provide stronger evidence in deciding the best approach to improve medication adherence.
本系统评价旨在评估改善哮喘患者药物依从性的干预措施的成本效益。使用 PubMed、Scopus 和 EBSCOhost 等搜索引擎从数据库建立之初到 2018 年 10 月 19 日搜索相关研究。使用 Drummond 清单评估经济评估的质量。选择评估提高哮喘患者药物依从性的干预措施的成本效益的经济研究。叙述性总结了相关信息，包括研究特征、质量评估、健康结果和干预成本。本综述共纳入 20 项研究，包括 11 项随机对照试验、6 项对照研究和 3 项使用马尔可夫模型的建模研究。其中，15 项研究评估了教育干预，其中 13 项研究显示在改善健康结果方面具有成本效益。基于互联网的干预措施的成本效益结果在组间相似，而 3 项简化药物方案和增加基于技术的培训计划的研究则实现了理想的成本效益结果。总的来说，我们的结果表明，考虑到增加的依从率、改善的临床效果和降低的哮喘护理成本，所有确定的药物依从性增强干预措施都是具有成本效益的。然而，尚无法确定最具成本效益的干预措施。需要更多具有良好方法学的经济研究来提供更强有力的证据，以确定改善药物依从性的最佳方法。
