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Persistency measurement and cost-effectiveness analysis
CLINICAL THERAPEUTICSWOL.
24, NO. 8,2002
Editorial Comment Persistency Measurement
and Cost-Effectiveness
Analysis
Even the best drugs do no good if they are not used. At the same time, patients who experience side effects may be reluctant to take their drugs as prescribed. Although these fundamental principles seem obvious to clinicians, their relevance to pharmacoeconomits and formulary decision-making is only now beginning to be appreciated. As noted by Degli Esposti et al in this issue of Clinical Therapeutics @, “findings from randomized controlled trials do not reflect actual patient behavior in community-practice settings.” It is important for us to look at the use of medications among real patients in the communityparticularly whether they take medicines as instructed by their physicians and how health outcomes are influenced by deviations from the physicians’ instructions. This is no simple task. Some investigators have built a career on distinguishing between adherence, persistence, and compliance, and developing methods of measuring each one. It seems straightforward that improved adherence translates into better health outcomes, yet there have been examples of “mostly compliant” and “fully compliant” patients seeming to benefit equally from pharmacotherapy; in fact, there have been cases of “partially compliant” and “fully compliant” patients achieving similar health outcomes. These counterintuitive results remind us that as scientists, we must not form conclusions based on theory alone. We must test our hypotheses to determine whether they hold up in actual practice among real patients. Outcomes research draws on the strengths of many disciplines, among them epidemiology, which has made significant contributions regarding the links between intermediate and final end points. Ideally, examinations of persistence, adherence, or compliance should be followed by studies of actual health outcomes. Investigations of differences in persistence across drug therapies would provide an additional piece of information for consideration by clinicians and formulary committees. Finally, studies of the link between persistence and outcomes would complete the picture.
C. Daniel Mullins, PhD Section Editor
1346
24, NO. 8,2002
Editorial Comment Persistency Measurement
and Cost-Effectiveness
Analysis
Even the best drugs do no good if they are not used. At the same time, patients who experience side effects may be reluctant to take their drugs as prescribed. Although these fundamental principles seem obvious to clinicians, their relevance to pharmacoeconomits and formulary decision-making is only now beginning to be appreciated. As noted by Degli Esposti et al in this issue of Clinical Therapeutics @, “findings from randomized controlled trials do not reflect actual patient behavior in community-practice settings.” It is important for us to look at the use of medications among real patients in the communityparticularly whether they take medicines as instructed by their physicians and how health outcomes are influenced by deviations from the physicians’ instructions. This is no simple task. Some investigators have built a career on distinguishing between adherence, persistence, and compliance, and developing methods of measuring each one. It seems straightforward that improved adherence translates into better health outcomes, yet there have been examples of “mostly compliant” and “fully compliant” patients seeming to benefit equally from pharmacotherapy; in fact, there have been cases of “partially compliant” and “fully compliant” patients achieving similar health outcomes. These counterintuitive results remind us that as scientists, we must not form conclusions based on theory alone. We must test our hypotheses to determine whether they hold up in actual practice among real patients. Outcomes research draws on the strengths of many disciplines, among them epidemiology, which has made significant contributions regarding the links between intermediate and final end points. Ideally, examinations of persistence, adherence, or compliance should be followed by studies of actual health outcomes. Investigations of differences in persistence across drug therapies would provide an additional piece of information for consideration by clinicians and formulary committees. Finally, studies of the link between persistence and outcomes would complete the picture.
C. Daniel Mullins, PhD Section Editor
1346