Impact of Unrecognized Dosing Errors on the Cost and Effectiveness of Pharmaceuticals

Abstract

Half of all patients comply properly with long-term drug therapy, reducing both benefit and drug procurement cost. Drug trials rarely show the effects of poor compliance, and so reveal average-compliance efficacy. An exception is cholestyramine, whose unique labeling makes a full-compliance efficacy claim twice the average-compliance efficacy claim. Had stronger methods for monitoring drug use been available, the data suggest that its full-compliance efficacy claim might have been even larger. A special pattern of erratic compliance, occurring in about 20% of patients per month, is a multiday interruption, called the “drug holiday,” now detectable by microelectronic monitoring methods. Clinical correlates of holidays are breakthrough failures of drug action, the projected cost of which equal drug procurement cost. Major cost reductions appear possible when routine microelectronic monitoring identifies holiday-prone patients. Tests of this projection merit high priority in the quest to contain health care costs.