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Measuring Non-Adherence and Non-Persistence

A number of methods currently exist to measure non-adherence and non-persistence of medical therapies, for improved understanding of their real-world uses. The optimal method for a given situation depend on specific elements of the context. A recent Cytel webinar convened by Dr. Sabrina Mueller and Dr. Thomas Wilke reviewed an array of such adherence measures before evaluating the virtues of three in particular.

Adherence refers specifically to whether or not patients are able and willing to follow a physician-recommended use of a specific therapy in the real-world, as opposed to within laboratory settings where patients might be more incentivized to participate. Measurements of adherence are important to payers and HTA authorities seeking to understand how a new medicine will operate once it has entered the market. Are patients unwilling to take the therapy due to poor interference with lifestyle (e.g. pills taken at odd hours), or for biological reasons (e.g. unanticipated adverse effects)? Will a doctor’s nudging affect behavior? How do factors like age affect a patient’s likelihood for adherence?

Ultimately, adherence measures help decision-makers understand whether effective therapies can have an impact in real world situations.

Medication Event Monitoring Systems (MEMS)

Medication event monitoring systems, or MEMS, are a measurement of adherence which utilizes tools like electronic pillboxes and other devices to monitor the adherence to a physician recommended therapy. Such systems can track whenever a relevant event occurs (e.g. the opening of a pillbox) and therefore also evaluate whether interventions like extended discussions with physicians about the importance of adherence can influence patient behavior, and by extension adherence. MEMS can be highly precise and objective, but do not offer the nuances of some other methods, such as those which clarify lifestyle factors and demographic elements to non-adherence practices.

Self-Reported Measures

An adherence assessment questionnaire (AAQ) offers patients a chance to report on how successfully they have followed a prescribed therapy. Such questionnaires have a series of questions that account for risk, and others which try to evaluate whether a patient will report more desirable outcomes (e.g. account for social desirability bias). One of the benefits of self-reported measures is that it offers a patient the chance to clarify whether the non-adherence had a specific and intentional cause (e.g. patients who stopped medication after intake caused sickness) versus those who might have forgotten to take medications due to busy schedules, etc.

Retrospective Claims Data

Non-adherence can be measured across several different parameters using retrospective claims data. Parameters can include dosage, calculation approaches, active agents, and numerous other considerations for highly nuanced analyses of the dynamics of non-adherence within a population. A case study of multiple myeloma displays the various benefits of using such retrospective claims data for adherence considerations. One of the benefits of utilizing claims data is that it can identify whether there are certain sub-populations particularly prone to become non-adherent. For example, perhaps younger people are more at risk to deviate from a prescribed course of treatment, or middle-aged people find adverse effects more intrusive due to effects on families with small children. Such patters are identifiable at the population level with large claims datasets.

To learn more about measuring non-adherence, click below to watch the webinar.

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About the Author of Blog: 

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Dr. Esha Senchaudhuri is a research and communications specialist, committed to helping scholars and scientists translate their research findings to public and private sector executives. At Cytel Esha leads content strategy and content production across the company's five business units. She received a doctorate from the London School of Economics in philosophy, and is a former early-career policy fellow of the American Academy of Arts and Sciences. She has taught medical ethics at the Harvard School of Public Health (TH Chan School), and sits on the Steering Committee of the Society for Women in Philosophy's Eastern Division, which is responsible for awarding the Distinguished Woman in Philosophy Award.