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cost-effectiveness, medication adherence, randomized controlled trial, transplant, SystemCHANGE



  1. Whittington, Melanie
  2. Goggin, Kathy
  3. Noel-MacDonnell, Janelle
  4. Hathaway, Donna
  5. Remy, Laura
  6. Aholt, Dana
  7. Clark, Debra
  8. Miller, Courtney
  9. Ashbaugh, Catherine
  10. Wakefield, Mark
  11. Ellis, Rebecca B.
  12. Russell, Cynthia


ABSTRACT: Interventions to improve medication nonadherence in transplantation have recently moved from a focus on motivation and intention, to a focus on person-level quality improvement strategies. These strategies link adherence to established daily routines, environmental cues, and supportive people. The objective of this evaluation was to estimate the cost of implementation and the cost-effectiveness of a person-level intervention shown to increase medication adherence. To estimate the intervention costs, a direct measure microcosting approach was used after key informant interviews with project champions and a review of implementation expenditures. Cost-effectiveness was calculated by comparing the incremental implementation costs and healthcare costs associated with nonadherence to the incremental percent adherent, defined as the percent of patients who took greater or equal to 85% of their medication doses, for each pairwise comparison. The intervention was low-resource to implement, costing approximately $520 to implement per patient, and was associated with significant improvements in medication adherence. These implementation costs were more than outweighed by the expected healthcare savings associated with improvements in adherence. This person-level intervention is a low-cost, efficacious intervention associated with significant statistical and clinical improvements in medication adherence in adult kidney transplant recipients.