Abstract
Background
Given the huge burden of coronary artery disease and the effectiveness of medication
therapy, understanding and quantifying known impacts of poor medication adherence
for primary and secondary prevention is crucial. We sought to systematically review
the literature on this topic area with a focus on quantified cost and clinical outcomes
related to adherence.
Methods
We conducted a systematic review of the literature between 1966 and November 2011
using a fixed search strategy, multiple reviewers, and a quality rating scale. We
found 2636 articles using this strategy, eventually weaning them down to 25 studies
that met our inclusion criteria. Three reviewers independently reviewed the studies
and scored them for quality using the Newcastle Ottawa Scoring Scale.
Results
We found 5 studies (4 of which focused on statins) that measured the impact of medication
adherence on primary prevention of coronary artery disease and 20 articles that focused
on the relationship between medication adherence to costs and outcomes related to
secondary prevention of coronary artery disease. Most of these latter studies focused
on antihypertensive medications and aspirin. All controlled for confounding comorbidities
and sociodemographic characteristics, but few controlled for likelihood of adherent
patients to have healthier behaviors (“healthy adherer effect”). Three studies found
that high adherence significantly improves health outcomes and reduces annual costs
for secondary prevention of coronary artery disease (between $294 and $868 per patient,
equating to 10.1%-17.8% cost reductions between high- and low-adherence groups). The
studies were all of generally of high quality on the Newcastle Ottawa Scale (median
score 8 of 9).
Conclusions
Increased medication adherence is associated with improved outcomes and reduced costs,
but most studies do not control for a “healthy adherer” effect.
Keywords
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Article Info
Footnotes
Funding: AB did not receive financial support for work on this study. WS, NC, and KS were supported by a research grant from CVS Caremark . OM is employed by CVS Caremark. All data analysis and evaluation took place at Brigham and Women's Hospital.
Conflict of Interest: AB declares no conflicts of interests. WS and NC have received funding from Aetna and Express Scripts. WS has received funding from Lilly, Teva, and the National Associations of Chain Drug Stores and has served as a consultant for United Healthcare. NC serves as a consultant for Mercer. OM is employed by CVS Caremark.
Authorship: All authors had access to the data and played a role in writing this manuscript.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
