dc.contributor.author	Sinnott, Sarah-Jo
dc.contributor.author	Buckley, Claire M.
dc.contributor.author	O'Riordan, David
dc.contributor.author	Bradley, Colin P.
dc.contributor.author	Whelton, Helen
dc.contributor.funder	Health Research Board	en
dc.date.accessioned	2016-02-17T11:46:18Z
dc.date.available	2016-02-17T11:46:18Z
dc.date.issued	2013
dc.description.abstract	Introduction: Copayments are intended to decrease third party expenditure on pharmaceuticals, particularly those regarded as less essential. However, copayments are associated with decreased use of all medicines. Publicly insured populations encompass some vulnerable patient groups such as older individuals and low income groups, who may be especially susceptible to medication non-adherence when required to pay. Non-adherence has potential consequences of increased morbidity and costs elsewhere in the system. Objective: To quantify the risk of non-adherence to prescribed medicines in publicly insured populations exposed to copayments. Methods: The population of interest consisted of cohorts who received public health insurance. The intervention was the introduction of, or an increase, in copayment. The outcome was non-adherence to medications, evaluated using objective measures. Eight electronic databases and the grey literature were systematically searched for relevant articles, along with hand searches of references in review articles and the included studies. Studies were quality appraised using modified EPOC and EHPPH checklists. A random effects model was used to generate the meta-analysis in RevMan v5.1. Statistical heterogeneity was assessed using the I-2 test; p>0.1 indicated a lack of heterogeneity. Results: Seven out of 41 studies met the inclusion criteria. Five studies contributed more than 1 result to the meta-analysis. The meta-analysis included 199, 996 people overall; 74, 236 people in the copayment group and 125,760 people in the non-copayment group. Average age was 71.75years. In the copayment group, (verses the non-copayment group), the odds ratio for non-adherence was 1.11 (95% CI 1.09-1.14; P = <0.00001). An acceptable level of heterogeneity at I-2 = 7%, (p = 0.37) was observed. Conclusion: This meta-analysis showed an 11% increased odds of non-adherence to medicines in publicly insured populations where copayments for medicines are necessary. Policy-makers should be wary of potential negative clinical outcomes resulting from non-adherence, and also possible knock-on economic repercussions.	en
dc.description.sponsorship	Health Research Board (grant no. PHD/2007/16)	en
dc.description.status	Peer reviewed	en
dc.description.version	Published Version	en
dc.format.mimetype	application/pdf	en
dc.identifier.articleid	e64914
dc.identifier.citation	Sinnott S-J, Buckley C, O′Riordan D, Bradley C, Whelton H (2013) The Effect of Copayments for Prescriptions on Adherence to Prescription Medicines in Publicly Insured Populations; A Systematic Review and Meta-Analysis. PLoS ONE 8(5): e64914. doi:10.1371/journal.pone.0064914	en
dc.identifier.doi	10.1371/journal.pone.0064914
dc.identifier.issn	1932-6203
dc.identifier.issued	5	en
dc.identifier.journaltitle	PLOS ONE	en
dc.identifier.uri	https://hdl.handle.net/10468/2376
dc.identifier.volume	8	en
dc.language.iso	en	en
dc.publisher	Public Library of Science	en
dc.rights	© 2013 Sinnott et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited	en
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/	en
dc.subject	Acute myocardial infarction	en
dc.subject	Administrative claims data	en
dc.subject	D coverage gap	en
dc.subject	Medication adherence	en
dc.subject	Copayment	en
dc.subject	Vulnerable populations	en
dc.subject	Diabetes mellitus	en
dc.subject	Health status	en
dc.subject	Drug therapy	en
dc.subject	Impact	en
dc.title	The effect of copayments for prescriptions on adherence to prescription medicines in publicly insured populations; A systematic review and meta-analysis	en
dc.type	Article (peer-reviewed)	en

The effect of copayments for prescriptions on adherence to prescription medicines in publicly insured populations; A systematic review and meta-analysis

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