The international generalisability of evidence for health policy: A cross country comparison of medication adherence following policy change

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dc.contributor.authorSinnott, Sarah-Jo
dc.contributor.authorWhelton, Helen
dc.contributor.authorFranklin Myers, Jessica
dc.contributor.authorPolinski, Jessica Milan
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2021-07-28T10:24:50Z
dc.date.available2021-07-28T10:24:50Z
dc.date.issued2016-10-26
dc.date.updated2021-07-28T10:16:35Z
dc.description.abstractCopayments for prescriptions may increase morbidity and mortality via reductions in adherence to medications. Relevant data can inform policy to minimise such unintended effects. We explored the generalisability of evidence for copayments by comparing two international copayment polices, one in Massachusetts and one in Ireland, to assess whether effects on medication adherence were comparable. We used national prescription data for public health insurance programmes in Ireland and Medicaid data in the U.S. New users of oral anti-hypertensive, anti-hyperlipidaemic and diabetic drugs were included (total n = 14,259 in U.S. and n = 43,843 in Ireland). We examined changes in adherence in intervention and comparator groups in each setting using segmented linear regression with generalised estimating equations. In Massachusetts, a gradual decrease in adherence to anti-hypertensive medications of -1% per month following the policy occurred. In contrast, the response in Ireland was confined to a -2.9% decrease in adherence immediately following the policy, with no further decrease over the 8 month follow-up. Reductions in adherence to oral diabetes drugs were larger in the U.S. group in comparison to the Irish group. No difference in adherence changes between the two settings for anti-hyperlipidaemic drugs occurred. Evidence on cost-sharing for prescription medicines is not 'one size fits all'. Time since policy implementation and structural differences between health systems may influence the differential impact of copayment policies in international settings.en
dc.description.sponsorshipHealth Research Board (Grant No PHD/2007/16)en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationSinnott, S.-J., Whelton, H., Franklin Myers, J. and Polinski, J. M. (2016) 'The international generalisability of evidence for health policy: A cross country comparison of medication adherence following policy change', Health Policy, 121(1), pp. 27-34. doi: 10.1016/j.healthpol.2016.10.009en
dc.identifier.doi10.1016/j.healthpol.2016.10.009en
dc.identifier.endpage34en
dc.identifier.issn0168-8510
dc.identifier.issued1en
dc.identifier.journaltitleHealth Policyen
dc.identifier.startpage27en
dc.identifier.urihttps://hdl.handle.net/10468/11600
dc.identifier.volume121en
dc.language.isoenen
dc.publisherElsevier B.V.en
dc.rights© 2016, Elsevier B.V. All rights reserved. This manuscript version is made available under the CC BY-NC-ND 4.0 license.en
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectPharmaceutical policyen
dc.subjectCost sharingen
dc.subjectMedication adherenceen
dc.subjectGeneralisabilityen
dc.titleThe international generalisability of evidence for health policy: A cross country comparison of medication adherence following policy changeen
dc.typeArticle (peer-reviewed)en
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