Up to 12-month outcomes and cost-effectiveness of a medication adherence-improving smartphone application (Perx) for Cardiometabolic and Endocrine conditions

Michelle Cunich, M Gail Del Olmo, Ang Li, Kyra A Sim, Mackenzie Fong, Sharyn J Lymer, Ian D Caterson

Background: Lack of effectiveness and cost-effectiveness studies of app interventions for medication adherence targeted at populations with conditions requiring polypharmacy.

Aims: Assess whether Perx app improves medication adherence, clinical outcomes and is cost-effective over 12-months compared to standard care in patients requiring polypharmacy.

Methods: RCT of Perx app (customised reminders with gamification to reward adherence). Participants aged 18–75, had >1 chronic condition, taking at least 3 different medications, had a smartphone. Recruited through outpatient clinics, tertiary hospitals, Sydney. Resource use measured with questionnaires; Incremental Cost Effectiveness Ratios (ICERs) calculated.

Results: Randomised 124 patients, 45 in Perx and 40 in control completed. Average age was 59.5, took 6 different medications, 58.9% women, 78% cardiovascular disease, and 75% type 2 diabetes, and 65% had obesity. Perx group had greater adherence-improvements than control throughout (12 months OR=2.61; 95%CI 1.07-6.41). Probability of normalised HbA1c was greater in Perx group than control at 9 and 12 months, and cholesterol was lower in Perx group than control at 3 months. Perx group had more GP (10.39 versus 8.97) and specialist attendances (7.66 versus 6.69) but less allied health (7.32 versus 9.86). ICER with Perx intervention was $112.15 per 1% adherence-improvement at 12 months; and $19.42 per 1% additional patients with normalised HbA1c at 12 months, $26.88 per 1% additional patients with normalised total cholesterol and $750.57 per 1 mmol/L lower in LDL-C at 3 months.

Conclusions: Limited resources were needed to implement Perx intervention but improvements observed for adherence and clinical outcomes over 12 months.