Computer-based HIV drug-adherence program cuts costs

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Developing a computer-based intervention to improve medication adherence among HIV patients becomes more cost-effective the longer patients stay on track and as the number of users grows, according to a paper published today in BMC Medical Informatics and Decision Making. Researchers sought to determine whether the initial high costs of development of such an intervention are offset by its benefits over time.

Previous research on the intervention--a one-hour program that patients completed on a touchscreen computer to educate them about the importance of taking their medication as directed in their fight against HIV--had already determined that the program helped increase the number who stay on track.

The computer-based intervention was believed to be more cost-effective than having the material provided by clinicians. Intensive interventions can involve multiple sessions and extensive staff time, costing as much as $4,000 a year, the researchers said. In some cases, interventions are not offered due to lack of trained personnel.

Because the research was funded through a grant, this work could easily establish itemized costs, but it also looked at wider costs, such as time missed from work for participants to complete the intervention. Though expected to contribute to better quality of life for patients, improved medication adherence also meant higher bills at the pharmacy. 

Overall, those with adherence less than 85 percent showed the greatest gains. The study put the total project cost at $296,411, with a cost for 124 participants at $2,390 each. Assuming an average increase of 10 percent per participant, development costs were $239 for each 1 percent increase in adherence.

The cost of providing the intervention (not including development costs) to each patient in a clinician's office under low and high utilization scenarios was $60, for a cost of $6 per 1 percent increase. That cost dropped to $52 for Internet delivery to 540 users semiannually, and for larger number of semiannual users, even with an increase in advertising budget, costs dropped to $27 per user, and a cost of $3 for each 1 percent increase.

Research published in Health Affairs earlier this month found that found that patients who do not take an active role in their healthcare cost 8 percent to 21 percent more than those that do. It also found those actively managing their health are more likely to engage in healthy behavior and use the health information they receive.

Patients who give their physicians high marks for communication are more likely to take their medication as directed, according to a study published in JAMA Internal Medicine. That study found that rates for medication non-adherence were 4 percent to 6 percent lower for patients who felt their doctors listened to them.

And in another illustration that follow-up matters, a study of adherence rates comparing the effectiveness of automated calls to those from nurses found that cancer patients responded respond equally well to both.

To learn more:
- find the research

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