{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T03:46:02Z","timestamp":1761709562725,"version":"3.40.5"},"reference-count":47,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,12,16]],"date-time":"2018-12-16T00:00:00Z","timestamp":1544918400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Medication non\u2010adherence influences outcomes of therapies for chronic diseases. Allopurinol is a cornerstone therapy for patients with gout; however, non\u2010adherence to allopurinol is prevalent in Singapore and limits its effectiveness. Between 2008\u20102010, an adherence\u2010enhancing program was implemented at the rheumatology division of a public tertiary hospital. The cost\u2010effectiveness of this program has not been fully evaluated. With healthcare resources being finite, the value of investing in adherence\u2010enhancing interventions should be ascertained. This study aims to evaluate the cost\u2010effectiveness of this adherence\u2010enhancing program to inform optimal resource allocation toward better gout management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Adopting a real\u2010world data approach, we utilized patient clinical and financial records generated in their course of routine care. Intervention and control groups were identified in a standing database and matched on nine risk factors through propensity score matching. Cost and effect data were followed through 1\u20102\u00a0years. A decision tree was developed in TreeAge using a societal perspective. Deterministic and probabilistic sensitivity analyses were performed to assess parameter uncertainty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At an assumed willingness\u2010to\u2010pay threshold of $50\u00a0000 USD ($70\u00a0000 SGD) per quality\u2010adjusted life year (QALY), the intervention had an 85% probability of being cost\u2010effective compared to routine care. The incremental cost\u2010effectiveness ratio was $12\u00a0866 USD per QALY for the base case and ranged from $4\u00a0139 to $21\u00a0593 USD per QALY in sensitivity analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The intervention is cost\u2010effective in the short\u2010term, although its long\u2010term cost\u2010effectiveness remains to be evaluated.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1756-185x.13446","type":"journal-article","created":{"date-parts":[[2018,12,17]],"date-time":"2018-12-17T07:55:31Z","timestamp":1545033331000},"page":"545-554","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cost\u2010effectiveness of an adherence\u2010enhancing intervention for gout based on real\u2010world data"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6203-081X","authenticated-orcid":false,"given":"Lydia Wenxin","family":"Lin","sequence":"first","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore Singapore Singapore"},{"name":"Department of Learning, Informatics, Management and Ethics Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gim Gee","family":"Teng","sequence":"additional","affiliation":[{"name":"Division of Rheumatology University Medicine Cluster, National University Health System Singapore Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita Yee Nah","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Rheumatology University Medicine Cluster, National University Health System Singapore Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne Su\u2010Yin","family":"Yoong","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niklas","family":"Zethraeus","sequence":"additional","affiliation":[{"name":"Department of Learning, Informatics, Management and Ethics Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hwee\u2010Lin","family":"Wee","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health National University of Singapore Singapore Singapore"},{"name":"Department of Pharmacy, Faculty of Science National University of Singapore Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,12,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep047"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0227"},{"issue":"5","key":"e_1_2_9_4_1","first-page":"453","article-title":"Cost\u2010effectiveness of febuxostat in chronic gout","volume":"15","author":"Beard SM","year":"2014","journal-title":"Eur J Heal Econ"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200666120-00002"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60883-7"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar2659"},{"key":"e_1_2_9_8_1","unstructured":"World Bank T.World Development Indicators: Singapore[Internet].2017[cited 2017 Apr 20]. 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