Effect of incentives for medication adherence on health care use and costs in methadone patients with HIV.
Identifieur interne : 001856 ( Main/Corpus ); précédent : 001855; suivant : 001857Effect of incentives for medication adherence on health care use and costs in methadone patients with HIV.
Auteurs : Paul G. Barnett ; James L. Sorensen ; Wynnie Wong ; Nancy A. Haug ; Sharon M. HallSource :
- Drug and alcohol dependence [ 1879-0046 ] ; 2009.
English descriptors
- KwdEn :
- Adult (MeSH), Anti-Retroviral Agents (economics), Anti-Retroviral Agents (therapeutic use), Delivery of Health Care (economics), Delivery of Health Care (statistics & numerical data), Drug Costs (MeSH), Female (MeSH), Follow-Up Studies (MeSH), HIV Infections (complications), HIV Infections (drug therapy), HIV Infections (economics), Humans (MeSH), Male (MeSH), Medication Adherence (MeSH), Methadone (economics), Methadone (therapeutic use), Middle Aged (MeSH), Motivation (MeSH), Opioid-Related Disorders (complications), Opioid-Related Disorders (drug therapy), Opioid-Related Disorders (economics).
- MESH :
- chemical , economics : Anti-Retroviral Agents, Methadone.
- chemical , therapeutic use : Anti-Retroviral Agents, Methadone.
- complications : HIV Infections, Opioid-Related Disorders.
- drug therapy : HIV Infections, Opioid-Related Disorders.
- economics : Delivery of Health Care, HIV Infections, Opioid-Related Disorders.
- statistics & numerical data : Delivery of Health Care.
- Adult, Drug Costs, Female, Follow-Up Studies, Humans, Male, Medication Adherence, Middle Aged, Motivation.
Abstract
BACKGROUND
The potential benefits of anti-retroviral therapy for HIV is not fully realized because of difficulties in adherence with demanding treatment regimens, especially among injection drug users.
METHODS
HIV-positive methadone patients who were less than 80% adherent with their primary anti-retroviral therapy were randomized to a trial of incentives for on-time adherence. Adherence was rewarded with an escalating scale of vouchers redeemable for goods. Both intervention and control group visited a medication coach twice a month. The cost of the intervention was determined by micro-costing. Other costs were obtained from administrative data and patient report of out-of-system care.
RESULTS
During the 12-week intervention period, the incremental direct cost of the intervention, including treatment vouchers, was $942. The voucher group incurred $2572 in anti-retroviral drug cost, significantly more than the $1973 incurred by the comparison group (p<.01). Adherence, as measured by on-time openings of an electronically monitored vial, was 78% in the intervention group and 56% in the control group.
CONCLUSIONS
The incremental direct cost of voucher incentives was $292 per month. If the observed increase in adherence from voucher incentives can be sustained in the long-term, the literature suggests that disease progression will be slowed. Further research is needed to evaluate if the improvement can be sustained or achieved at lower cost. Mitigation of treatment resistance and reduction in HIV transmission are additional benefits that favor adoption.
DOI: 10.1016/j.drugalcdep.2008.09.017
PubMed: 19054631
PubMed Central: PMC2715338
Links to Exploration step
pubmed:19054631Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effect of incentives for medication adherence on health care use and costs in methadone patients with HIV.</title><author><name sortKey="Barnett, Paul G" sort="Barnett, Paul G" uniqKey="Barnett P" first="Paul G" last="Barnett">Paul G. Barnett</name><affiliation><nlm:affiliation>Veterans Affairs Health Economics Resource Center, 795 Willow Rd. (152 MPD), VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. paul.barnett@va.gov</nlm:affiliation></affiliation></author><author><name sortKey="Sorensen, James L" sort="Sorensen, James L" uniqKey="Sorensen J" first="James L" last="Sorensen">James L. Sorensen</name></author><author><name sortKey="Wong, Wynnie" sort="Wong, Wynnie" uniqKey="Wong W" first="Wynnie" last="Wong">Wynnie Wong</name></author><author><name sortKey="Haug, Nancy A" sort="Haug, Nancy A" uniqKey="Haug N" first="Nancy A" last="Haug">Nancy A. Haug</name></author><author><name sortKey="Hall, Sharon M" sort="Hall, Sharon M" uniqKey="Hall S" first="Sharon M" last="Hall">Sharon M. Hall</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2009">2009</date><idno type="RBID">pubmed:19054631</idno><idno type="pmid">19054631</idno><idno type="doi">10.1016/j.drugalcdep.2008.09.017</idno><idno type="pmc">PMC2715338</idno><idno type="wicri:Area/Main/Corpus">001856</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">001856</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Effect of incentives for medication adherence on health care use and costs in methadone patients with HIV.</title><author><name sortKey="Barnett, Paul G" sort="Barnett, Paul G" uniqKey="Barnett P" first="Paul G" last="Barnett">Paul G. Barnett</name><affiliation><nlm:affiliation>Veterans Affairs Health Economics Resource Center, 795 Willow Rd. (152 MPD), VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. paul.barnett@va.gov</nlm:affiliation></affiliation></author><author><name sortKey="Sorensen, James L" sort="Sorensen, James L" uniqKey="Sorensen J" first="James L" last="Sorensen">James L. Sorensen</name></author><author><name sortKey="Wong, Wynnie" sort="Wong, Wynnie" uniqKey="Wong W" first="Wynnie" last="Wong">Wynnie Wong</name></author><author><name sortKey="Haug, Nancy A" sort="Haug, Nancy A" uniqKey="Haug N" first="Nancy A" last="Haug">Nancy A. Haug</name></author><author><name sortKey="Hall, Sharon M" sort="Hall, Sharon M" uniqKey="Hall S" first="Sharon M" last="Hall">Sharon M. Hall</name></author></analytic><series><title level="j">Drug and alcohol dependence</title><idno type="eISSN">1879-0046</idno><imprint><date when="2009" type="published">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Anti-Retroviral Agents (economics)</term><term>Anti-Retroviral Agents (therapeutic use)</term><term>Delivery of Health Care (economics)</term><term>Delivery of Health Care (statistics & numerical data)</term><term>Drug Costs (MeSH)</term><term>Female (MeSH)</term><term>Follow-Up Studies (MeSH)</term><term>HIV Infections (complications)</term><term>HIV Infections (drug therapy)</term><term>HIV Infections (economics)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Medication Adherence (MeSH)</term><term>Methadone (economics)</term><term>Methadone (therapeutic use)</term><term>Middle Aged (MeSH)</term><term>Motivation (MeSH)</term><term>Opioid-Related Disorders (complications)</term><term>Opioid-Related Disorders (drug therapy)</term><term>Opioid-Related Disorders (economics)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="economics" xml:lang="en"><term>Anti-Retroviral Agents</term><term>Methadone</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Retroviral Agents</term><term>Methadone</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>HIV Infections</term><term>Opioid-Related Disorders</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>HIV Infections</term><term>Opioid-Related Disorders</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Delivery of Health Care</term><term>HIV Infections</term><term>Opioid-Related Disorders</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Delivery of Health Care</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Drug Costs</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Male</term><term>Medication Adherence</term><term>Middle Aged</term><term>Motivation</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>The potential benefits of anti-retroviral therapy for HIV is not fully realized because of difficulties in adherence with demanding treatment regimens, especially among injection drug users.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>HIV-positive methadone patients who were less than 80% adherent with their primary anti-retroviral therapy were randomized to a trial of incentives for on-time adherence. Adherence was rewarded with an escalating scale of vouchers redeemable for goods. Both intervention and control group visited a medication coach twice a month. The cost of the intervention was determined by micro-costing. Other costs were obtained from administrative data and patient report of out-of-system care.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>During the 12-week intervention period, the incremental direct cost of the intervention, including treatment vouchers, was $942. The voucher group incurred $2572 in anti-retroviral drug cost, significantly more than the $1973 incurred by the comparison group (p<.01). Adherence, as measured by on-time openings of an electronically monitored vial, was 78% in the intervention group and 56% in the control group.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>The incremental direct cost of voucher incentives was $292 per month. If the observed increase in adherence from voucher incentives can be sustained in the long-term, the literature suggests that disease progression will be slowed. Further research is needed to evaluate if the improvement can be sustained or achieved at lower cost. Mitigation of treatment resistance and reduction in HIV transmission are additional benefits that favor adoption.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">19054631</PMID><DateCompleted><Year>2009</Year><Month>11</Month><Day>12</Day></DateCompleted><DateRevised><Year>2019</Year><Month>05</Month><Day>08</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1879-0046</ISSN><JournalIssue CitedMedium="Internet"><Volume>100</Volume><Issue>1-2</Issue><PubDate><Year>2009</Year><Month>Feb</Month><Day>01</Day></PubDate></JournalIssue><Title>Drug and alcohol dependence</Title><ISOAbbreviation>Drug Alcohol Depend</ISOAbbreviation></Journal><ArticleTitle>Effect of incentives for medication adherence on health care use and costs in methadone patients with HIV.</ArticleTitle><Pagination><MedlinePgn>115-21</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.drugalcdep.2008.09.017</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">The potential benefits of anti-retroviral therapy for HIV is not fully realized because of difficulties in adherence with demanding treatment regimens, especially among injection drug users.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">HIV-positive methadone patients who were less than 80% adherent with their primary anti-retroviral therapy were randomized to a trial of incentives for on-time adherence. Adherence was rewarded with an escalating scale of vouchers redeemable for goods. Both intervention and control group visited a medication coach twice a month. The cost of the intervention was determined by micro-costing. Other costs were obtained from administrative data and patient report of out-of-system care.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">During the 12-week intervention period, the incremental direct cost of the intervention, including treatment vouchers, was $942. The voucher group incurred $2572 in anti-retroviral drug cost, significantly more than the $1973 incurred by the comparison group (p<.01). Adherence, as measured by on-time openings of an electronically monitored vial, was 78% in the intervention group and 56% in the control group.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">The incremental direct cost of voucher incentives was $292 per month. If the observed increase in adherence from voucher incentives can be sustained in the long-term, the literature suggests that disease progression will be slowed. Further research is needed to evaluate if the improvement can be sustained or achieved at lower cost. Mitigation of treatment resistance and reduction in HIV transmission are additional benefits that favor adoption.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Barnett</LastName><ForeName>Paul G</ForeName><Initials>PG</Initials><AffiliationInfo><Affiliation>Veterans Affairs Health Economics Resource Center, 795 Willow Rd. 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