Living your best life with arthritis.

The cost of non-adherence to prescribed medications

Pills and needles to portray medication nonadherenceAn article published in the Annals of Internal Medicine estimated that non-adherence resulted in approximately 125,000 deaths and at least 10 percent of hospitalizations, costing US health care system $100 and $289 billion a year.

The article reports that “studies have consistently shown that 20 percent to 30 percent of medication prescriptions are never filled, and that approximately 50 percent of medications for chronic diseases are not taken as prescribed. The review found that for people who do take prescription medications, they only take about half the prescribed doses.

Researchers from Northwestern University found that one-third of kidney transplant patients don’t take their anti-rejection medications. Other studies show that 41 percent of heart attack patients don’t take their blood pressure medications and only 50 percent of children with asthma use their inhalers as prescribed.

In an article in the New York Times, Dr. Bruce Bender, co-director of the Centre for Health Promotion at National Jewish Health in Denver, explained: “When people don’t take the medications prescribed for them, emergency department visits and hospitalizations increase and more people die. Non-adherence is a huge problem, and there’s no one solution because there are many different reasons why it happens.”

Dr. Bender uses asthma as an example. Parents often stop their children’s asthma treatment to avoid giving too much medications to their kids. Kids living with asthma have an underlying inflammation in the lungs and without the recommended dose of asthma medication, a simple cold could last six weeks or longer.

When Dr. Lisa Rosenbaum, a cardiologist at Brigham and Women’s Hospital in Boston, surveyed her patients about why they are not taking their prescribed medications, the responses include:

  • I don’t want to become a pill person.
  • My medications remind me that I’m sick.
  • Medications are unnatural and full of chemicals.
  • I’ve tried tapering off on my medications and I do not notice any difference in my health.
  • I’m worried about the side effects of my medications.
  • My medications are too costly. When medications are very expensive, like the biologics used to treat rheumatoid arthritis that cost $4,000 a month, patients are less likely to follow the prescribed dosage.
  • My prescription is too complicated.
  • I am not having any of the disease symptoms.
  • Taking medications is a sign of weakness.

Medication non-adherence can result in negative outcomes such as unnecessary worsening of symptoms or progression of the condition or disease, increased healthcare visits, the need for more medications or hospitalizations, and even an increased risk of death. Studies have shown that non-adherence to long-term therapy contributes to an increased burden on healthcare. According to a World Health Organization (WHO) report entitled “Adherence to long-term therapies: evidence for action 2003”, the findings include:

  • Adherence levels can fall quickly after starting therapy.
  • Adherence to long-term therapy for chronic illnesses in developed countries averages only 50%.
  • Non-adherence wastes resources, represents a missed opportunity for therapeutic benefit, and is associated with poorer patient outcomes.
  • Non-adherence is a leading cause of preventable morbidity, mortality, and cost.

At the University of British Columbia (UBC), Mary De Vera, Assistant Professor and recipient of the Professorship in Medication Adherence with the UBC Faculty of Pharmaceutical Sciences, said that the objective of the Professorship is to conduct research and share knowledge and best practices on medication adherence and its connection to improved health outcomes and healthcare sustainability. The Professorship includes such innovative techniques as developing the first ever “living laboratory” whereby practicing pharmacists will learn new skills in working with patients on adherence issues.

Dr. De Vera cites numbers that are truly scary:

  • $7 – 9 billion: the estimated annual cost of non-adherence in Canada in 1995.
  • $300 billion: more recent cost estimates from the United States.
  • 69%: the proportion of medication-related hospitalizations due to non-adherence.
  • 125,000: the number of unnecessary deaths per year due to non-adherence.

From the findings of her PhD research, Dr. De Vera adds to these statistics: patients with rheumatoid arthritis who stopped taking statins raised their risk of a heart attack by 67% and death by 80%.

In an interview with Arthritis Consumer Experts, Dr. De Vera said: “Medication non-adherence is truly an epidemic and as a pharmacoepidemiologist, my research program is focused on moving toward multi-disciplinary approaches to understanding and solving this health problem. It will take engaging patients, physicians, pharmacists, other healthcare professionals, and policy makers to build multi-disciplinary teams and provide unique perspectives to the problem. It will take involving not just patients but their support network. It will take borrowing tools from other disciplines and bringing them together. It will take the willingness to create new knowledge.”

Luckily, doctors, pharmacists and patients can all work together to combat non-adherence. There are digital technology and apps for patients to track their treatment regimes. Doctors and pharmacists can also use these apps to interact with patients, such as sending medication refill and medication taking reminders. Some systems also allow patients to interact digitally with their healthcare team.

Patients should also discuss their concerns about side effects with their doctors during the therapy conversation. Understanding the possible side effects of a medication will empower patients to monitor their own health and report back to their doctor about any adverse effects, which will help them determine the therapy that works best for you.