Adherence to long-term prophylactic treatment: microeconomic analysis of patients’ behavior and the impact of financial incentives

Springer Science and Business Media LLC - Tập 9 - Trang 1-10 - 2019
Klaus Mann1, Michael Möcker2, Joachim Grosser2
1Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
2Chair of Economic Policy, University of Hagen, Hagen, Germany

Tóm tắt

The effectiveness of medical therapies depends crucially on patients’ adherence. To gain deeper insight into the behavioral mechanisms underlying adherence, we present a microeconomic model of the decision-making process of an individual who is initially in an asymptomatic clinical state and to whom a prophylactic therapy is offered with the aim of preventing damage to health in the future. The focus of modeling is the optimization of an intertemporal utility function, where time-inconsistent preferences are incorporated by a quasi-hyperbolic discount function. The predictions of the model concur with experience in clinical practice. Moreover, the introduction of time-inconsistency reveals a self-control problem of the individuals where resolutions made before may be given up at a later time. A more pronounced present bias leads to a decrease in adherence and, consequently, the gain in societal welfare resulting from the prophylactic therapy declines. Developing effective strategies to improve adherence is a major challenge in health care. As an example, the impact of financial incentives offered to the patients on adherence and welfare are investigated on the basis of the model. The results are consistent with empirical findings. The approach presented contributes to a better understanding of the complex interaction of the relevant determinants for adherence, particularly regarding the individuals’ self-control problem.

Tài liệu tham khảo

World Health Organization (WHO). Adherence to long-term therapies: evidence for action. 2003. http://www.who.int/chp/knowledge/publications/adherence_report/en/. Accessed 15 May 2018. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–97. Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86:304–14. Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006;333(7557):15. Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ Open. 2018;8(1):e016982. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002;288:2868–79. Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014;11:CD000011. Costa E, Giardini A, Savin M, Menditto E, Lehane E, Laosa O, et al. Interventional tools to improve medication adherence: review of literature. Patient Prefer Adherence. 2015;9:1303–14. Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, Kaufman C, et al. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev. 2014;4:CD007768. Giuffrida A, Gravelle H. Paying patients to comply: an economic analysis. Health Econ. 1998;7:569–79. Feldman SR, Chen GJ, Hu JY, Fleischer AB. Effects of systematic asymmetric discounting on physician-patient interactions: a theoretical framework to explain poor compliance with lifetime counseling. BMC Med Inform Decis Mak. 2002;2:8. Lamiraud K, Geoffard PY. Therapeutic non-adherence: a rational behavior revealing patient preferences? Health Econ. 2007;16:1185–204. Elliott RA, Shinogle JA, Peele P, Bhosle M, Hughes DA. Understanding medication compliance and persistence from an economic perspective. Value Health. 2008;11:600–10. Loewenstein G, Brennan T, Volpp KG. Asymmetric paternalism to improve health behaviors. JAMA. 2007;298:2415–7. Mealem Y, Siniver E, Yaniv G. Patient compliance, physician empathy and financial incentives within a principal-agent framework. J Socio-Econ. 2012;41:827–30. Djawadi BM, Fahr R, Turk F. Conceptual model and economic experiments to explain nonpersistence and enable mechanism designs fostering behavioral change. Value Health. 2014;17:814–22. Heshmat S. Behavioral economics of self-control failure. Yale J Biol Med. 2015;88:333–7. Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs. A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(4):e5641. Durand H, Hayes P, Morrissey EC, Newell J, Casey M, Murphy AW, et al. Medication adherence among patients with apparent treatment-resistant hypertension: systematic review and meta-analysis. J Hypertension. 2017;35:2346–57. Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med. 2012;125:882–7. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665. Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013;34:2940–8. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 4. Effects of various classes of antihypertensive drugs – overview and meta-analysis. J Hypertension. 2015;33:195–211. Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387:435–43. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–67. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43:521–30. Bitton A, Choudhry NK, Matlin OS, Swanton K, Shrank WH. The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review. Am J Med. 2013;126:357.e7–357.e27. Vrijens B, Antoniou S, Burnier M, de la Sierra A, Volpe M. Current situation of medication adherence in hypertension. Front Pharmacol. 2017;8:100. Mennini FS, Marcellusi A, Graf von der Schulenburg JM, Gray A, Levy P, Sciattella P, et al. Cost of poor adherence to anti-hypertensive therapy in five European countries. Eur J Health Econ. 2015;16:65–72. Frederick S, Loewenstein G, O’Donoghue T. Time discounting and time preference: a critical review. J Econ Lit. 2002;40:351–401. DellaVigna S, Malmendier U. Contract design and self-control: theory and evidence. Q J Econ. 2004;119:353–402. Samuelson PA. A note on measurement of utility. Rev Econ Stud. 1937;4:155–61. Angeletos GM, Laibson D, Repetto A, Tobacman J, Weinberg S. The hyperbolic consumption model: calibration, simulation, and empirical evaluation. J Econ Perspect. 2001;15:47–68. DellaVigna S. Psychology and economics: evidence from the field. J Econ Lit. 2009;47:315–72. Augenblick N, Niederle M, Sprenger C. Working over time: dynamic inconsistency in real effort tasks. Q J Econ. 2015;130:1067–115. O’Donoghue T, Rabin M. Present bias: lessons learned and to be learned. Am Econ Rev. 2015;105:273–9. Phelps ES, Pollak RA. On second-best national saving and game-equilibrium growth. Rev Econ Stud. 1968;35:185–99. Laibson D. Golden eggs and hyperbolic discounting. Q J Econ. 1997;112:443–77. O’Donoghue T, Rabin M. Doing it now or later. Am Econ Rev. 1999;89:103–24. O’Donoghue T, Rabin M. Choice and procrastination. Q J Econ. 2001;116:121–60. O’Donoghue T, Rabin M. Studying optimal paternalism, illustrated by a model of sin taxes. Am Econ Rev. 2003;93:186–91. Bickel WK, Marsch LA. Toward a behavioral economic understanding of drug dependence: delay discounting processes. Addiction. 2001;96:73–86. Bickel WK, Jarmolowicz DP, Mueller ET, Koffarnus MN, Gatchalian KM. Excessive discounting of delayed reinforcers as a trans-disease process contributing to addiction and other disease-related vulnerabilities: emerging evidence. Pharmacol Therapeutics. 2012;134:287–97. Carrillo JD. To be consumed with moderation. Eur Econ Rev. 2005;49:99–111. DellaVigna S, Malmendier U. Paying not to go to the gym. Am Econ Rev. 2006;96:694–719. Axon RN, Bradford WD, Egan BM. The role of individual time preferences in healthy behaviors among hypertensive adults: a pilot study. J Am Soc Hypertension. 2009;3:35–41. Bradford WD. The association between individual time preferences and health maintenance habits. Med Decis Mak. 2010;30:99–112. Koffarnus MN, Jarmolowicz DP, Mueller ET, Bickel WK. Changing delay discounting in the light of the competing neurobehavioral decision systems theory: a review. J Exp Anal Behav. 2013;99:32–57. Bickel WK, Koffarnus MN, Moody L, Wilson AG. The behavioral- and neuro-economic process of temporal discounting: a candidate behavioral marker of addiction. Neuropharmacology 2014;76 Pt B:518–527. Barlow P, McKee M, Reeves A, Galea G, Stuckler D. Time-discounting and tobacco smoking: a systematic review and network analysis. Int J Epidem. 2017;46:860–9. Barlow P, Reeves A, McKee M, Galea G, Stuckler D. Unhealthy diets, obesity and time discounting: a systematic literature review and network analysis. Obesity Rev. 2016;17:810–9. Van der Pol M, Hennessy D, Manns B. The role of time and risk preferences in adherence to physician advice on health behavior change. Eur J Health Econ. 2017;18:373–86. Brocas I, Carrillo JD. Dual-process theories of decision-making: a selective survey. J Econ Psychol. 2014;41:45–54. Strack F, Deutsch R. Reflective and impulsive determinants of social behavior. Personal Soc Psychol Rev. 2004;8:220–47. Alós-Ferrer C, Strack F. From dual processes to multiple selves: implications for economic behavior. J Econ Psychol. 2014;41:1–11. McClure SM, Laibson DI, Loewenstein G, Cohen JD. Separate neural systems value immediate and delayed monetary rewards. Science. 2004;306:503–7. Bechara A. Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective. Nat Neurosci. 2005;8:1458–63. Berns GS, Laibson D, Loewenstein G. Intertemporal choice – toward an integrative framework. Trends Cogn Sci. 2007;11:482–8. Kalenscher T, Pennartz CM. Is a bird in the hand worth two in the future? The neuroeconomics of intertemporal decision-making. Prog Neurobiol. 2008;84:284–315. Peters J, Büchel C. The neural mechanisms of inter-temporal decision-making: understanding variability. Trends Cogn Sci. 2011;15:227–39. Fobbs WC, Mizumori SJY. A framework for understanding and advancing intertemporal choice research using rodent models. Neurobiol Learning Memory. 2017;139:89–97. Loewenstein G. Anticipation and the evaluation of delayed consumption. Econ J. 1987;97:666–84. Caplin A, Leahy J. Psychological expected utility theory and anticipatory feelings. Q J Econ. 2001;116:55–79. Carrillo JD, Mariotti T. Strategic ignorance as a self-disciplining device. Rev Econ Stud. 2000;67:529–44. Brocas I, Carrillo JD. The value of information when preferences are dynamically inconsistent. Eur Econ Rev. 2000;44:1104–15. Strotz RH. Myopia and inconsistency in dynamic utility maximization. Rev Econ Stud. 1955;23:165–80. Brocas I, Carrillo JD, Dewatripont M. Commitment devices under self-control problems: an overview. In: Brocas I, Carrillo JD, editors. The psychology of economic decisions. Volume 2: reasons and choices. New York: Oxford University Press; 2004. p. 49–65. Bryan G, Karlan D, Nelson S. Commitment devices. Annu Rev Econom. 2010;2:671–98. Foster C, McDonald S, Frize G, Ayers S, Fidler S. “Payment by results” – financial incentives and motivational interviewing, adherence interventions in young adults with perinatally acquired HIV-1 infection: a pilot program. AIDS Patient Care STDs. 2014;28:28–32. Halpern SD, French B, Small DS, Saulsgiver K, Harhay MO, Audrain-McGovern J, et al. Randomized trial of four financial-incentive programs for smoking cessation. N Engl J Med. 2015;372:2108–17. Priebe S, Bremner SA, Lauber C, Henderson C, Burns T. Financial incentives to improve adherence to antipsychotic maintenance medication in non-adherent patients: a cluster randomised controlled trial. Health Technol Assess. 2016;20:1–122. Noordraven EL, Wierdsma AI, Blanken P, Bloemendaal AF, Staring AB, Mulder CL. Financial incentives for improving adherence to maintenance treatment in patients with psychotic disorders (money for medication): a multicentre, open-label, randomised controlled trial. Lancet Psychiatry. 2017;4:199–207. Hsu J, Price M, Huang J, Brand R, Fung V, Hui R, et al. Unintended consequences of caps on Medicare drug benefits. N Engl J Med. 2006;354:2349–59. Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: associations with medication and medical utilization and spending and health. JAMA. 2007;298:61–9. Choudhry NK, Avorn J, Glynn RJ, Antman EM, Schneeweiss S, Toscano M, et al. Full coverage for preventive medications after myocardial infarction. N Engl J Med. 2011;365:2088–97. Simon HA. A behavioral model of rational choice. Q J Econ. 1955;69:99–118. Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science. 1981;211:453–8. Loewenstein G, Volpp KG, Asch DA. Incentives in health: different prescriptions for physicians and patients. JAMA. 2012;307:1375–6. Loewenstein G, Asch DA, Volpp KG. Behavioral economics holds potential to deliver better results for patients, insurers, and employers. Health Aff. 2013;32:1244–50. Tversky A, Kahneman D. Judgement under uncertainty: heuristics and biases. Science. 1974;185:1124–31. Gigerenzer G, Gaissmaier W. Heuristic decision making. Annu Rev Psychol. 2011;62:451–82. Redelmeier DA, Rozin P, Kahneman D. Understanding patients‘ decisions. Cognitive and emotional perspectives. JAMA. 1993;270:72–6. Slovic P, Peters E, Finucane ML, MacGregor DG. Affect, risk, and decision making. Health Psychol. 2005;24:S35–40. Kahneman D, Frederick S. Frames and brains: elicitation and control of response tendencies. Trends Cogn Sci. 2006;11:45–6. Lerner JS, Li Y, Valdesolo P, Kassam KS. Emotion and decision making. Annu Rev Psychol. 2015;66:799–823. Loewenstein GF, Weber EU, Hsee CK, Welch N. Risk as feelings. Psychol Bull. 2001;127:267–86.