E-DRUG: Effect of Copayments for Prescriptions on Adherence - Systematic Review
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Dear Colleagues
About copayment I´d like to share the following article published in PLOS
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0064914
The Effect of Copayments for Prescriptions on Adherence to Prescription
Medicines in Publicly Insured Populations; A Systematic Review and
Meta-Analysis
by Sarah-Jo Sinnott, Claire Buckley, David O′Riordan, Colin Bradley, Helen Whelton
Abstract
Introduction
Copayments are intended to decrease third party expenditure on
pharmaceuticals, particularly those regarded as less essential. However,
copayments are associated with decreased use of all medicines. Publicly
insured populations encompass some vulnerable patient groups such as older
individuals and low income groups, who may be especially susceptible to
medication non-adherence when required to pay. Non-adherence has potential
consequences of increased morbidity and costs elsewhere in the system.
Objective
To quantify the risk of non-adherence to prescribed medicines in publicly
insured populations exposed to copayments.
Methods
The population of interest consisted of cohorts who received public health
insurance. The intervention was the introduction of, or an increase, in
copayment. The outcome was non-adherence to medications, evaluated using
objective measures. Eight electronic databases and the grey literature were
systematically searched for relevant articles, along with hand searches of
references in review articles and the included studies. Studies were
quality appraised using modified EPOC and EHPPH checklists. A random
effects model was used to generate the meta-analysis in RevMan v5.1.
Statistical heterogeneity was assessed using the I2 test; p>0.1 indicated a
lack of heterogeneity.
Results
Seven out of 41 studies met the inclusion criteria. Five studies
contributed more than 1 result to the meta-analysis. The meta-analysis
included 199, 996 people overall; 74, 236 people in the copayment group and
125,760 people in the non-copayment group. Average age was 71.75years. In
the copayment group, (verses the non-copayment group), the odds ratio for
non-adherence was 1.11 (95% CI 1.09–1.14; P = <0.00001). An acceptable
level of heterogeneity at I2 = 7%, (p = 0.37) was observed.
Conclusion
This meta-analysis showed an 11% increased odds of non-adherence to
medicines in publicly insured populations where copayments for medicines
are necessary. Policy-makers should be wary of potential negative clinical
outcomes resulting from non-adherence, and also possible knock-on economic
repercussions.
Regards
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Antonio Villafaina Barroso
Pharm PhD at Spanish NHS
http://www.polimedicado.com/
Antonio Villafaina Barroso <antonio.villafaina@gmail.com>