Medication Nonadherence – Costs & Deaths

What is medication nonadherence?

According to a report from the Council for Affordable Health Coverage, medication adherence is “when a patient takes their medications according to the specific dosage, time, and frequency prescribed. A breakdown in any one of these elements (nonadherence) has the potential to result in unanticipated side effects and complications. Despite this:

• Half of all patients do not take their medications as prescribed
• 20% of all new prescriptions go unfilled
• Adherence is lowest among patients with chronic illnesses”

What are the effects of nonadherence?

IMS Healthcare’s 2013 report “Avoidable Costs in U.S. Healthcare” states that, at minimum, nonadherence is responsible for $105.4 billion of avoidable healthcare costs in the US (3.9% of the $2.7 trillion spent on healthcare in 2012).
The Council for Affordable Health Coverage claims that nonadherence is responsible for:

• 125,000 Americans die annually (89,000 with hypertension) due to poor medication adherence.
• Patients who take medications as prescribed may save as much as $7,800 per patient annually.
• As adherence declines, emergency room visits increase by 17% and hospital stays rise 10% among patients with diabetes, asthma, or gastric acid disorder.
• Poor medication adherence results in 33 to 69% of medication-related hospital admissions in the United States, at a cost of roughly $100 billion per year.
• The New England Healthcare Institute estimates that total potential savings from adherence and related disease management could be $290 billion annually—13% of health spending.

What issues are related to nonadherence?

In “Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions“, an article by Voleli et al in 2009, a review of e-prescriptions for over 75,000 patients was performed to examine which of various characteristics were associated with nonadherence.
The key results of their multivariate analysis for all medications:

The analysis indicates that certain characteristics are related to higher and lower adherence rates. For example, what may be seen in the chart is that dermatologic agents are associated with a higher degree of nonadherence than asthma drugs: an odds ratio of 0.53 vs. asthma medicines’ 1.02 OR (antimicrobials were the referent, OR of 1.0). Another example is a lower OR for prescription adherence for those written by female versus male physicians.

What can be done to reduce nonadherence?

A July 2013 report, “Thinking Outside the Pillbox: Six Priorities for Action to Support Improved Patient Medication Adherence“, from The New England Healthcare Institute (NEHI), recommends actions be taken within the following six broad themes:

1. “Promote sharing of best practices and lessons learned from pilots of new medication management techniques
2. Support large-scale implementation of promising, evidence-based “tactics” for improved medication management
3. Continue development of metrics of medication use that will spur adoption of proven medication management strategies
4. Support continued rapid adoption of electronic prescribing and electronic medical records with capabilities that support evidence-based interventions for improved adherence
5. Continue to improve Medication Therapy Management services in Medicare Part D including improvements in program services and targeting; consider wider adoption of medication management by other health care payers
6. Integrate medication adherence research, policy development and advocacy with broader efforts that aim to improve use of medicines, including those focused on patient safety.”