• Open Access

The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review


  • Disclosures The data in this paper were presented in part at the 16th European Meeting on Hypertension, 12–15 June 2006, Madrid, Spain and ISPOR 9th Annual European Congress, 28–31 October 2006, Copenhagen, Denmark. Development of this manuscript was sponsored by Novartis Pharma AG. Joyce Cramer does not have a direct or indirect financial interest in Novartis Pharma AG, nor has she received an honorarium to author this manuscript. Ágnes Benedict and Noémi Muszbek are employees of United BioSource. As a research organisation, United BioSource conducted the original literature review upon which this article is based. United BioSource has undertaken similar projects for other pharmaceutical companies. Abdulkadir Keskinaslan and Zeba M. Khan are directly employed by Novartis Pharma AG and Novartis Pharmaceuticals Corporation respectively. Editorial support was provided by Rx Communications Limited.

  • Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

Joyce A. Cramer,
Yale University School of Medicine, 950 Campbell Ave, (Room 7-127, G7E), West Haven, CT 06516-2770, USA
Tel.: + 1 203 937 3894
Fax: + 1 203 937 3468
Email: joyce.cramer@yale.edu


Objectives:  To review studies of patient compliance/persistence with cardiovascular or antidiabetic medication published since the year 2000; to compare the methods used to measure compliance/persistence across studies; to compare reported compliance/persistence rates across therapeutic classes and to assess whether compliance/persistence correlates with clinical outcomes.

Methods:  English language papers published between January 2000 and November 2005 investigating patient compliance/persistence with cardiovascular or antidiabetic medication were identified through searches of the MEDLINE and EMBASE databases. Definitions and measurements of compliance/persistence were compared across therapeutic areas using contingency tables.

Results:  Of the 139 studies analysed, 32% focused on hypertension, 27% on diabetes and 13% on dyslipidaemia. The remainder covered coronary heart disease and cardiovascular disease (CVD) in general. The most frequently reported measure of compliance was the 12-month medication possession ratio (MPR). The overall mean MPR was 72%, and the MPR did not differ significantly between treatment classes (range: 67–76%). The average proportion of patients with an MPR of > 80% was 59% overall, 64% for antihypertensives, 58% for oral antidiabetics, 51% for lipid-lowering agents and 69% in studies of multiple treatments, again with no significant difference between treatment classes. The average 12-month persistence rate was 63% and was similar across therapeutic classes. Good compliance had a positive effect on outcome in 73% of the studies examining clinical outcomes.

Conclusions:  Non-compliance with cardiovascular and antidiabetic medication is a significant problem, with around 30% of days ‘on therapy’ not covered by medication and only 59% of patients taking medication for more than 80% of their days ‘on therapy’ in a year. Good compliance has a positive effect on clinical outcome, suggesting that the management of CVD may be improved by improving patient compliance.