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Medical News

Effect of Incentives for Medication Adherence on Health Care Use and Costs in Methadone Patients With HIV

February 11, 2009

The potential benefits of antiretroviral therapy for HIV patients are "not fully realized because of difficulties in adherence with demanding treatment regimens, especially among injection drug users," the authors wrote.

In the current study, HIV-positive methadone patients who were less than 80 percent adherent to their primary antiretroviral therapy were randomized to a trial of incentives for on-time adherence. Vouchers redeemable for goods were issued on an escalating scale to reward adherence. Both intervention and control groups visited a medication coach twice a month. Micro-costing was employed to determine the cost of the intervention. Administrative data and patients' reports of out-of-system care were accessed to obtain other cost information.

During the 12-week intervention, the incremental direct cost of the intervention, including treatment vouchers, was $942. Adherence, as measured by on-time openings of an electronically monitored medication vial, was 78 percent in the intervention group and 56 percent in the control group. The voucher group incurred $2,572 in antiretroviral drug costs, compared with $1,973 for the control group (p<.01>
"The incremental direct cost of voucher incentives was $292 per month," the authors concluded. "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."

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Adapted from:
Drug and Alcohol Dependence
02.01.2009; Vol. 100; Issues 1-2: P. 115-121; Paul G. Barnett; James L. Sorensen; Wynnie Wong; Nancy A. Haug; Sharon M. Hall

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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
See Also
6 Reasons Why People Skip Their HIV Meds
Word on the Street: Advice on Adhering to HIV Treatment
More HIV Treatment Adherence Research