How to build adherence into practice


Detailed report available on NICE's proposals for value based assessment of health technologies

Value Based Assessment

Most estimates of medication adherence suggest that between a third and a half of medicines prescribed for long term conditions are not taken as recommended. This translates into between £2.7bn and over £4bn of medicines used incorrectly, according to the National Institute for Health and Clinical Excellence. The cost of treating patients with low levels of adherence can be double that of patients with high levels of adherence. It is not only costs that worsen, in a study of diabetes and heart disease patients, non-adherent patients had significantly higher mortality rates than adherent patients (12.1 per cent versus 6.7 per cent).

There are strong economic and clinical arguments for making a priority of addressing poor adherence. The evidence shows that in order to achieve the best possible chance of medicines adherence the patient has to be involved in decisions about their medicines to the degree that they want to be. This starts when the medicine is first prescribed and continues throughout the time that they are taking the medicine. 

If we are serious about tackling poor medicines adherence then we must make sure that the support processes are in place and address barriers to adherence which may be compounding the problem.


Addressing poor adherence should be a national priority. It requires a multi-factoral approach and the development of incentives to encourage prescribers and pharmacists to make adherence support a routine aspect of care. But, we cannot address poor adherence without also addressing practices that compound the problem, such as constantly changing generics.

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