Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia.
Macquarie University Centre for the Health Economy, North Ryde, Australia.
PLoS One. 2022 Jun 29;17(6):e0269836. doi: 10.1371/journal.pone.0269836. eCollection 2022.
Depression, osteoporosis, and cardiovascular disease impose a heavy economic burden on society. Understanding economic impacts of suboptimal use of medication due to nonadherence and non-persistence (non-MAP) for these conditions is important for clinical practice and health policy-making.
This systematic literature review aims to assess the impact of non-MAP to antidepressants, bisphosphonates and statins on healthcare resource utilisation and healthcare cost (HRUHC), and to assess how these impacts differ across medication classes.
A systematic literature review and an aggregate meta-analysis were performed. Using the search protocol developed, PubMed, Cochrane Library, ClinicalTrials.gov, JSTOR and EconLit were searched for articles that explored the relationship between non-MAP and HRUHC (i.e., use of hospital, visit to healthcare service providers other than hospital, and healthcare cost components including medical cost and pharmacy cost) published from November 2004 to April 2021. Inverse-variance meta-analysis was used to assess the relationship between non-MAP and HRUHC when reported for at least two different populations.
Screening 1,123 articles left 10, seven and 13 articles on antidepressants, bisphosphonates, and statins, respectively. Of those, 27 were rated of good quality, three fair and none poor using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. In general, non-MAP was positively associated with HRUHC for all three medication classes and most prominently for bisphosphonates, although the relationships differed across HRUHC components and medication classes. The meta-analysis found that non-MAP was associated with increased hospital cost (26%, p = 0.02), outpatient cost (10%, p = 0.01), and total medical cost excluding pharmacy cost (12%, p<0.00001) for antidepressants, and increased total healthcare cost (3%, p = 0.07) for bisphosphonates.
This systematic literature review is the first to compare the impact of non-MAP on HRUHC across medications for three prevalent conditions, depression, osteoporosis and cardiovascular disease. Positive relationships between non-MAP and HRUHC highlight inefficiencies within the healthcare system related to non-MAP, suggesting a need to reduce non-MAP in a cost-effective way.
抑郁、骨质疏松和心血管疾病给社会带来了沉重的经济负担。了解这些疾病因不遵医嘱和不坚持用药（非 MAP）而导致药物使用不当对临床实践和卫生政策制定具有重要意义。
本系统文献综述旨在评估抗抑郁药、双磷酸盐和他汀类药物的非 MAP 对医疗资源利用和医疗保健成本（HRUHC）的影响，并评估这些影响在药物类别之间的差异。
进行了系统文献综述和综合荟萃分析。使用制定的搜索方案，在 PubMed、Cochrane Library、ClinicalTrials.gov、JSTOR 和 EconLit 中搜索了 2004 年 11 月至 2021 年 4 月期间发表的探讨非 MAP 与 HRUHC（即医院使用、医院以外的医疗服务提供者就诊、医疗成本组成部分包括医疗成本和药房成本）之间关系的文章。当报告至少有两个不同人群的关系时，使用逆方差荟萃分析来评估非 MAP 与 HRUHC 之间的关系。
筛选出 1123 篇文章后，分别有 10、7 和 13 篇文章关于抗抑郁药、双磷酸盐和他汀类药物。其中，27 篇文章使用观察性队列和横断面研究质量评估工具被评为质量良好，3 篇为中等，没有一篇为差。总的来说，非 MAP 与所有三种药物类别以及双磷酸盐的 HRUHC 呈正相关，尽管在 HRUHC 组成部分和药物类别之间存在差异。荟萃分析发现，非 MAP 与抗抑郁药的住院费用增加（26%，p = 0.02）、门诊费用增加（10%，p = 0.01）和总医疗费用（不包括药房费用）增加（12%，p<0.00001）以及双磷酸盐的总医疗保健成本增加（3%，p = 0.07）相关。
这是第一项比较三种常见疾病（抑郁症、骨质疏松症和心血管疾病）中三种常见疾病因非 MAP 导致的 HRUHC 差异的系统文献综述。非 MAP 与 HRUHC 之间的正相关关系突出了与非 MAP 相关的医疗保健系统中的效率低下，表明需要以具有成本效益的方式减少非 MAP。
