• Open Access

The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review


  • Disclosures The data in this paper were presented in part at the 16th European Meeting on Hypertension, Madrid, Spain, 12–15 June 2006.
    Noemi Muszbek and Agnes Benedict 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.
    Diana Brixner has received unrestricted research grants from Novartis Pharma AG. However, she has not received an honorarium to author this manuscript.

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

Noemi Muszbek,
United BioSource Corporation, 20 Bloomsbury Square, London WC1A 2NS, UK
Tel.: + 44 20 7299 4550
Fax: + 44 20 7299 4555
Email: noemi.muszbek@unitedbiosource.com


Objectives:  To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions.

Methods:  English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively.

Results:  Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified.

Conclusions:  Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue.