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Economic impact of medication non-adherence by disease groups: a systematic review
  1. Rachelle Louise Cutler1,
  2. Fernando Fernandez-Llimos2,
  3. Michael Frommer3,
  4. Charlie Benrimoj1,
  5. Victoria Garcia-Cardenas1
  1. 1 Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
  2. 2 Department of Social Pharmacy Faculty of Pharmacy, Research Institute for Medicines (iMed.ULisboa), University of Lisbon, Lisbon, Portugal
  3. 3 Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Rachelle Louise Cutler; rachelle.cutler{at}


Objective To determine the economic impact of medication non-adherence across multiple disease groups.

Design Systematic review.

Evidence review A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist.

Results Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to ‘all causes’ non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents.

Conclusion Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required.

PROSPERO registration number CRD42015027338.

  • health economics
  • health policy
  • quality in health care
  • public health
  • adherence

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  • Contributors RLC and VGC performed all the data extraction and quality assessment. RLC drafted the initial form and all revisions of this manuscript. All authors conceived the paper, made significant contributions to the manuscript and read and modified the drafts, and read and approved the final manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RLC’s research is supported by an Australian Government Research Training Program Scholarship.

  • Patient consent Not requried.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data from systematic review available in paper and supplementary material.

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