The Cost of Medication Nonadherence

Medication adherence is generally defined as the extent to which patients take medication as prescribed by their doctors. This involves factors such as getting prescriptions filled, remembering to take medications on time, and understanding the directions. Surprisingly, 50% of patients do not take their medications as prescribed.

Patient nonadherence to prescribed medications is associated with:

  • Progression of disease
  • Poor therapeutic outcomes
  • Avoidable direct health care costs
  • Productivity costs.

A big picture point of view shows that poor medication adherence results in approximately $100 billion per year in wasteful healthcare spending. Figure 2 cited in a study by the IMS Institute for Healthcare Informatics shows those costs by care setting.

Figure 1
A big picture point of view shows that poor medication adherence results in approximately $100 billion per year in wasteful healthcare spending. – Brandon Conroy, Practice Director, Retirement Analytics.

There is substantial evidence that the long-term cost of poor outcomes exceeds the cost of medications in many chronic illnesses.

Contributing Factors

Factors contributing to poor medication adherence are wide ranging and complex, and vary by role. They include:

  • Patients
    • A lack of health literacy
    • Don’t believe that the treatment is necessary or helping
    • Difficulty keeping up with multiple medications and complex dosing schedules
  • Physicians
    • Complex drug regimens
    • Communication barriers
    • Ineffective communication of information about adverse effects
    • Multiple physicians prescribing medications and treatments
  • Healthcare Systems
    • Office visit time limitations
    • Limited access to care
    • Lack of health information technology.

Nonadherence by Disease*

Cardiovascular complications resulting from hypertension, hyperlipidemia, and diabetes lead to substantial disability, morbidity, and mortality.

  • For every increase of 20 mm Hg in systolic BP and every increase of 10 mm Hg in diastolic BP, the risk of stroke and ischemic heart disease doubles.

Medications reduce the risk of stroke by approximately 30% and myocardial infarction by approximately 15%. Despite that, evidence from a number of studies suggests that:

  • As many as 50% to 80% of patients treated for hypertension are nonadherent to their treatment regimen.
Figure 2

 


 

Figure 3
As many as 50% to 80% of patients treated for hypertension are nonadherent to their treatment regimen, according to studies.
  • Within 6 months to 1 year after having been prescribed statins, approximately 25% to 50% of patients discontinue them. At the end of 2 years, nonadherence is as high as 75%.

Nonadherence to lipid-lowering and antiplatelet therapies is associated with an increased risk of adverse cardiovascular outcomes.

  • In a study of 500 drug-eluting stent recipients, 13.6% of patients discontinued the therapy within 30 days.
    • These patients had a 10-fold greater mortality rate at 1 year than those who continued therapy (7.5% vs 0.7%).

*Source for statistics cited in this section: Medication Adherence: WHO Cares?

Nonadherence Impacts More than Healthcare Costs

Researchers have estimated that health-related productivity losses are 2.3 times higher than direct healthcare costs (JOEM).

Another study from the Journal of Occupational and Environmental Medicine (JOEM), “Impact of Medication Adherence on Absenteeism and Short-Term Disability for Five Chronic Diseases,” estimated absenteeism and disability costs due to medication nonadherence. Figure 4 below depicts some of the findings.

 

Figure 4

How Much is Nonadherence Costing Your Company?

Do you know how many of your employees and their dependents are taking their medications as prescribed? Is noncompliance impacting your disability costs, absenteeism rates, and productivity?

If you can’t answer these questions you can’t design effective programs to address the issues.

Your benefits data holds the answers. Make benefits data analytics a New Year’s resolution for 2019.

I wish all my readers a safe and happy holiday season, and a prosperous New Year. I will post my next blog on January 16.

 

Brandon Conroy

Brandon Conroy

Brandon Conroy, ASA, FCA, MAAA, is a leader in developing and implementing new tools and strategies that reduce client risk. He’s developed and implemented an interactive healthcare cost projection model, underwriting templates, renewal presentations, IBNR tools, a health plan chooser tool, and financial wellness education models. Brandon left Innovu in February 2019 to pursue other interests.

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