The costs of medication non-adherence in healthcare can be staggering, both in money spent and health outcomes. The following Risk Management and Healthcare Policy medication adherence statistics are examples of how large a problem this is:
- An estimated $100 to $300 billion is spent on health care costs due to non-adherence to medication therapy
- For patients with chronic diseases, adherence to medication is about 50%
- Twenty-five percent of hospitalizations can be attributed to medication non-adherence
- Non-adherence is thought to be responsible for about 125,000 deaths per year in the United States.
Non-adherence is a complicated issue with many causes. In this blog, we look into the causes and examine the costs — both monetary and social — to get a clearer picture of the problem.
What Is Medication Non-Adherence?
The World Health Organization (WHO) defines medication adherence as “the degree to which the person’s behavior corresponds with the agreed recommendation from a health care provider.” Medication non-adherence happens when a patient is deviating from the agreed upon therapy that takes into account the patient’s lifestyle, opinions, and goals of care along with the doctor’s medical advice. We should mention that the current thinking suggests the term compliance is different than adherence. Compliance suggests that the patient is merely following an order from the doctor with no input from the patient. Hence, the preference is to currently use the terms adherence or non-adherence and not medication non-compliance or compliance.
The World Health Organization also believes that five connecting factors determine patient adherence:
- Social and economic factors: Poverty, illiteracy, education, a high cost of medication, transportation issues and costs, cultural beliefs, age, and race
- Health care team and system factors: Inadequate insurance reimbursement, poor communication and consultation with patients, lack of community support, and lack of knowledge of adherence problems and solutions
- Condition-related factors: Severity of a patient’s condition, level of disability, the progression of patient’s disease, and the availability of treatments
- Therapy-related factors: Duration and complexity of treatment, previous failures, how often treatment changes are made, side effects, and the availability of medical support
- Patient-related factors: Patient knowledge, beliefs, and expectations of their disease
After briefly looking into the definition and possible causes of patient medication non-adherence, the focus will now turn to costs of medication non-adherence for patients and the healthcare system in general.
Costs for Patients and the Healthcare System
The costs of medication non-adherence go beyond just economic costs to the patient and the healthcare system. As medication non-adherence becomes an issue, it can potentially start a vicious cycle of decreasing health, increasing health costs, and lost time for both the patient and the healthcare system. What follows is a look at some of the costs of medication non-adherence.
Increasing Healthcare Costs
When talking about medication non-adherence, the most common costs mentioned are the economic ones associated with patients becoming non-adherent. One study looked at the economic effects of medication non-adherence by disease state. The study found:
- Hypertension: The all-cause total healthcare costs for non-adherent patients was $543 to $2,852 more depending on adherence level
- Hypercholesterolemia: The all-cause total healthcare costs for non-adherent patients was $4 to $4,164 more depending on adherence level
- Diabetes: The all-cause total healthcare costs for non-adherent patients was $4,092 to $7,612 more depending on adherence level
Increased costs in disease state management due to medication non-adherence can be from the need to take more medications to manage a disease, hospitalizations due to worsening of disease, and development of new conditions due to worsening of disease like stroke or myocardial infarction for hypertension and hypercholesterolemia.
Hospitalization is known to increase costs. Medicare has the Hospital Readmission Reduction Program that penalizes hospitals not meeting yearly standards. One study looked at the correlation between Medicare patient medication adherence and hospital readmission after 30 days. It found that patients with intermediate and low medication adherence had a 20% readmission rate. The readmission rate for patients with high medication adherence was 9.3%.
Hospitalization risk also increased when adherence rates decreased according to the study from above. (Sokol M 2005) Let’s look at the same three disease states:
- Hypertension: Hospitalization rates ranged from 19% for high adherence rates (>80%) to 28% for low adherence rates (1-19%)
- Hypercholesterolemia: Hospitalization rates ranged from 12% for high adherence rates (>80%) to 15% for low adherence rates (1-19%)
- Diabetes: Hospitalization rates ranged from 13% for high adherence rates (>80%) to 30% for low adherence rates (1-19%)
As patient prescription adherence improves, the hospitalization risk decreases and in turn results in a reduction of total healthcare costs.
Costs to the Patient
There can be more than just monetary costs to the patient when medication non-adherence occurs. For most patients, time and quality of life are just as important to them as money — for many they are worth even more. Therefore, the costs of non-adherence should also be factored into the equation.
Oxford Dictionaries defines the quality of life as the standard of health, comfort, and happiness experienced by an individual or group. One study for Parkinson’s disease looked at the relationship of improved quality of life in Parkinson’s disease patients when an adherence therapy program was started. The results found a significant improvement in the quality of life for those with Parkinson’s disease. This supports the thought that medication non-adherence has costs beyond monetary ones.
For some patients, time is the most valuable commodity they may have. Worsening disease state due to lack of adherence can significantly affect the amount of time a patient may be able to call his or her own. This is especially true for patients with diabetes. One study reported that patients receiving insulin and those with self-reported poor health were spending more time on diabetes self-care. For other disease states, the time costs may come in the form of more doctor visits, trips to specialists or hospitalizations.
There are many costs to medication non-adherence. The costs may come in the form of monetary, increased hospitalizations, quality of life, or time costs. Both patients and the healthcare system pay the price for patients not adhering to medication regimens. Studies support the fact that improving medication adherence will result in lower health care costs, improved patient quality of life, and more time for patients to partake in the activities they want to do.