Cost-effectiveness and impact on healthcare utilization of interventions to improve medication adherence and outcomes in asthma and COPD: A systematic literature review

Job F M van Boven; Federico Lavorini; Tamas Agh; Mohsen Sadatsafavi; Oliver Patino; Bogdan Muresan

doi:10.1016/j.jaip.2023.12.049

Cost-effectiveness and impact on healthcare utilization of interventions to improve medication adherence and outcomes in asthma and COPD: A systematic literature review

Job F M van Boven^*, Federico Lavorini, Tamas Agh, Mohsen Sadatsafavi, Oliver Patino, Bogdan Muresan

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

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Abstract

BACKGROUND: Poor adherence to asthma and chronic obstructive pulmonary disease (COPD) maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence and persistence are not yet in widespread, regular use. Implementation costs are a potential barrier to uptake of such programs.

OBJECTIVE: We undertook a systematic literature review and narrative synthesis of studies investigating the cost-effectiveness of treatment adherence-promoting programs or that determined their impact on healthcare budget directly or via healthcare resource utilization (HCRU).

METHODS: We identified relevant publications using MEDLINE and PREMEDLINE (PubMed), EMBASE (Embase.com, Elsevier) and EconLit for publications between January 2000 and July 2021. Clinical trial databases and selected conference proceedings were also searched.

RESULTS: Of 1,910 potentially relevant articles, 26 met prespecified inclusion criteria and underwent data extraction. Eleven reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. None included analysis of biologic medication use. Where studied, interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU - healthcare visits, hospital admissions and/or the use of medications (including add-on/reliever treatment and antibiotics) - were reported frequently. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases where favorable outcomes were observed.

CONCLUSION: Adherence-promoting interventions are mostly cost-effective and often result in reduced HCRU and associated costs. Multidisciplinary care involving one-to-one advice and digitally enhanced communications appear to offer the greatest benefit.

Original language	English
Pages (from-to)	1228-1243
Number of pages	16
Journal	The journal of allergy and clinical immunology. In practice
Volume	12
Issue number	5
Early online date	3-Jan-2024
DOIs	https://doi.org/10.1016/j.jaip.2023.12.049
Publication status	Published - May-2024

Keywords

Asthma
COPD
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
HEALTH ECONOMIC-EVALUATION
COST EFFECTIVENESS
LUNG DISEASES
MEDICATION ADHERENCE
INHALER DEVICES

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van Boven, J. F. M., Lavorini, F., Agh, T., Sadatsafavi, M., Patino, O., & Muresan, B. (2024). Cost-effectiveness and impact on healthcare utilization of interventions to improve medication adherence and outcomes in asthma and COPD: A systematic literature review. The journal of allergy and clinical immunology. In practice, 12(5), 1228-1243. https://doi.org/10.1016/j.jaip.2023.12.049

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title = "Cost-effectiveness and impact on healthcare utilization of interventions to improve medication adherence and outcomes in asthma and COPD: A systematic literature review",

abstract = "BACKGROUND: Poor adherence to asthma and chronic obstructive pulmonary disease (COPD) maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence and persistence are not yet in widespread, regular use. Implementation costs are a potential barrier to uptake of such programs.OBJECTIVE: We undertook a systematic literature review and narrative synthesis of studies investigating the cost-effectiveness of treatment adherence-promoting programs or that determined their impact on healthcare budget directly or via healthcare resource utilization (HCRU).METHODS: We identified relevant publications using MEDLINE and PREMEDLINE (PubMed), EMBASE (Embase.com, Elsevier) and EconLit for publications between January 2000 and July 2021. Clinical trial databases and selected conference proceedings were also searched.RESULTS: Of 1,910 potentially relevant articles, 26 met prespecified inclusion criteria and underwent data extraction. Eleven reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. None included analysis of biologic medication use. Where studied, interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU - healthcare visits, hospital admissions and/or the use of medications (including add-on/reliever treatment and antibiotics) - were reported frequently. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases where favorable outcomes were observed.CONCLUSION: Adherence-promoting interventions are mostly cost-effective and often result in reduced HCRU and associated costs. Multidisciplinary care involving one-to-one advice and digitally enhanced communications appear to offer the greatest benefit.",

keywords = "Asthma, COPD, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, HEALTH ECONOMIC-EVALUATION, COST EFFECTIVENESS, LUNG DISEASES, MEDICATION ADHERENCE, INHALER DEVICES",

author = "{van Boven}, {Job F M} and Federico Lavorini and Tamas Agh and Mohsen Sadatsafavi and Oliver Patino and Bogdan Muresan",

note = "Copyright {\textcopyright} 2024. Published by Elsevier Inc.",

year = "2024",

month = may,

doi = "10.1016/j.jaip.2023.12.049",

language = "English",

volume = "12",

pages = "1228--1243",

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van Boven, JFM, Lavorini, F, Agh, T, Sadatsafavi, M, Patino, O & Muresan, B 2024, 'Cost-effectiveness and impact on healthcare utilization of interventions to improve medication adherence and outcomes in asthma and COPD: A systematic literature review', The journal of allergy and clinical immunology. In practice, vol. 12, no. 5, pp. 1228-1243. https://doi.org/10.1016/j.jaip.2023.12.049

Cost-effectiveness and impact on healthcare utilization of interventions to improve medication adherence and outcomes in asthma and COPD: A systematic literature review. / van Boven, Job F M; Lavorini, Federico; Agh, Tamas et al.
In: The journal of allergy and clinical immunology. In practice, Vol. 12, No. 5, 05.2024, p. 1228-1243.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Cost-effectiveness and impact on healthcare utilization of interventions to improve medication adherence and outcomes in asthma and COPD

T2 - A systematic literature review

AU - van Boven, Job F M

AU - Lavorini, Federico

AU - Agh, Tamas

AU - Sadatsafavi, Mohsen

AU - Patino, Oliver

AU - Muresan, Bogdan

PY - 2024/5

Y1 - 2024/5

N2 - BACKGROUND: Poor adherence to asthma and chronic obstructive pulmonary disease (COPD) maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence and persistence are not yet in widespread, regular use. Implementation costs are a potential barrier to uptake of such programs.OBJECTIVE: We undertook a systematic literature review and narrative synthesis of studies investigating the cost-effectiveness of treatment adherence-promoting programs or that determined their impact on healthcare budget directly or via healthcare resource utilization (HCRU).METHODS: We identified relevant publications using MEDLINE and PREMEDLINE (PubMed), EMBASE (Embase.com, Elsevier) and EconLit for publications between January 2000 and July 2021. Clinical trial databases and selected conference proceedings were also searched.RESULTS: Of 1,910 potentially relevant articles, 26 met prespecified inclusion criteria and underwent data extraction. Eleven reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. None included analysis of biologic medication use. Where studied, interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU - healthcare visits, hospital admissions and/or the use of medications (including add-on/reliever treatment and antibiotics) - were reported frequently. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases where favorable outcomes were observed.CONCLUSION: Adherence-promoting interventions are mostly cost-effective and often result in reduced HCRU and associated costs. Multidisciplinary care involving one-to-one advice and digitally enhanced communications appear to offer the greatest benefit.

AB - BACKGROUND: Poor adherence to asthma and chronic obstructive pulmonary disease (COPD) maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence and persistence are not yet in widespread, regular use. Implementation costs are a potential barrier to uptake of such programs.OBJECTIVE: We undertook a systematic literature review and narrative synthesis of studies investigating the cost-effectiveness of treatment adherence-promoting programs or that determined their impact on healthcare budget directly or via healthcare resource utilization (HCRU).METHODS: We identified relevant publications using MEDLINE and PREMEDLINE (PubMed), EMBASE (Embase.com, Elsevier) and EconLit for publications between January 2000 and July 2021. Clinical trial databases and selected conference proceedings were also searched.RESULTS: Of 1,910 potentially relevant articles, 26 met prespecified inclusion criteria and underwent data extraction. Eleven reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. None included analysis of biologic medication use. Where studied, interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU - healthcare visits, hospital admissions and/or the use of medications (including add-on/reliever treatment and antibiotics) - were reported frequently. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases where favorable outcomes were observed.CONCLUSION: Adherence-promoting interventions are mostly cost-effective and often result in reduced HCRU and associated costs. Multidisciplinary care involving one-to-one advice and digitally enhanced communications appear to offer the greatest benefit.

KW - Asthma

KW - COPD

KW - CHRONIC OBSTRUCTIVE PULMONARY DISEASE

KW - HEALTH ECONOMIC-EVALUATION

KW - COST EFFECTIVENESS

KW - LUNG DISEASES

KW - MEDICATION ADHERENCE

KW - INHALER DEVICES

U2 - 10.1016/j.jaip.2023.12.049

DO - 10.1016/j.jaip.2023.12.049

M3 - Review article

C2 - 38182099

SN - 2213-2198

VL - 12

SP - 1228

EP - 1243

JO - The journal of allergy and clinical immunology. In practice

JF - The journal of allergy and clinical immunology. In practice

IS - 5

ER -

van Boven JFM, Lavorini F, Agh T, Sadatsafavi M, Patino O, Muresan B. Cost-effectiveness and impact on healthcare utilization of interventions to improve medication adherence and outcomes in asthma and COPD: A systematic literature review. The journal of allergy and clinical immunology. In practice. 2024 May;12(5):1228-1243. Epub 2024 Jan 3. doi: 10.1016/j.jaip.2023.12.049

Cost-effectiveness and impact on healthcare utilization of interventions to improve medication adherence and outcomes in asthma and COPD: A systematic literature review

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