Adherence and health care costs

Aurel O Iuga, Maura J McGuire, Aurel O Iuga, Maura J McGuire

Abstract

Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e)-prescribing.

Keywords: adherence; compliance; cost; medication; nonadherence; noncompliance; patient.

Figures

Figure 1
Figure 1
Conceptual diagram displaying a mechanism that may contribute to the maintenance of the medication nonadherence problem within the US health care system.
Figure 2
Figure 2
Selected determinants of medication adherence.

References

    1. Centers for Medicare and Medicaid Services, editor. NHE Projections 2010–2020. Washington, DC: US Department of Health and Human Services; 2011.
    1. Kaiser Family Foundation, editor. Health care costs: a primer. [Accessed August 7, 2013]. Available from: .
    1. Schroeder SA. Shattuck lecture. We can do better – improving the health of the American people. N Engl J Med. 2007;357(12):1221–1228.
    1. The US Department of Treasury, editor. The 2012 annual report of the boards of trustees of the federal hospital insurance and federal supplementary medical insurance trust funds. 2012. [Accessed August 7, 2013]. Available from: .
    1. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513–1516.
    1. DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42(3):200–209.
    1. IMS Institute for Healthcare Informatics Avoidable costs in US health care. 2013. Available at: . Accessed September 10, 2013.
    1. DiMatteo MR. Evidence-based strategies to foster adherence and improve patient outcomes. JAAPA. 2004;17(11):18–21.
    1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–497.
    1. Hansen RA, Farley JF, Droege M, Maciejewski ML. A retrospective cohort study of economic outcomes and adherence to monotherapy with metformin, pioglitazone, or a sulfonylurea among patients with type 2 diabetes mellitus in the United States from 2003 to 2005. Clin Ther. 2010;32(7):1308–1319.
    1. Bosworth HB, Granger BB, Mendys P, et al. Medication adherence: A call for action. Am Heart J. 2011;162(3):412–424.
    1. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: Its importance in cardiovascular outcomes. Circulation. 2009;119(23):3028–3035.
    1. LaFleur J, Oderda GM. Methods to measure patient compliance with medication regimens. J Pain Palliat Care Pharmacother. 2004;18(3):81–87.
    1. Karve S, Cleves MA, Helm M, Hudson TJ, West DS, Martin BC. Good and poor adherence: Optimal cut-point for adherence measures using administrative claims data. Curr Med Res Opin. 2009;25(9):2303–2310.
    1. Sikka R, Xia F, Aubert RE. Estimating medication persistency using administrative claims data. Am J Manag Care. 2005;11(7):449–457.
    1. Hepke KL, Martus MT, Share DA. Costs and utilization associated with pharmaceutical adherence in a diabetic population. Am J Manag Care. 2004;10(2 Pt 2):144–151.
    1. Herndon JB, Mattke S, Evans Cuellar A, Hong SY, Shenkman EA. Anti-inflammatory medication adherence, health care utilization and expenditures among medicaid and children’s health insurance program enrollees with asthma. Pharmacoeconomics. 2012;30(5):397–412.
    1. Express Scripts 2011 drug trend report. 2012. [Accessed September 21, 2013]. Available from: .
    1. Lavsa SM, Holzworth A, Ansani NT. Selection of a validated scale for measuring medication adherence. J Am Pharm Assoc (2003) 2011;51(1):90–94.
    1. Marcum ZA, Sevick MA, Handler SM. Medication nonadherence: A diagnosable and treatable medical condition. JAMA. 2013;309(20):2105–2106.
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.
    1. Martinez ML, Vande Griend JP, Linnebur SA. Medication management: A case of brown bag-identified medication hoarding. Consult Pharm. 2012;27(10):729–736.
    1. Harbig P, Barat I, Lund Nielsen P, Damsgaard EM. Instantaneous detection of nonadherence: Quality, strength, and weakness of an electronic prescription database. Pharmacoepidemiol Drug Saf. 2012;21(3):323–328.
    1. Rand CS, Wise RA. Measuring adherence to asthma medication regimens. Am J Respir Crit Care Med. 1994;149(2 Pt 2):S69–S76. discussion S77–S78.
    1. Lauzardo M, Peloquin CA. Antituberculosis therapy for 2012 and beyond. Expert Opin Pharmacother. 2012;13(4):511–526.
    1. National Center for Health Statistics Health, United States, 2012: With special feature on emergency care. 2013. [Accessed September 21, 2013]. Available from: .
    1. Haynes RB, Montague P, Oliver T, McKibbon KA, Brouwers MC, Kanani R. Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev. 2000;(2):CD000011.
    1. Centers for Disease Control and Prevention Chronic diseases and health promotion. 2013. [Accessed September 21, 2013]. Available from: .
    1. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and health care cost. Med Care. 2005;43(6):521–530.
    1. Mattke S, Martorell F, Hong SY, Sharma P, Cuellar A, Lurie N. Anti-inflammatory medication adherence and cost and utilization of asthma care in a commercially insured population. J Asthma. 2010;47(3):323–329.
    1. Vermiere E, Avonts D, Van Royen P, Buntinx F, Denekens J. Context and health outcomes. Lancet. 2001;357(9273):2059–2060.
    1. Sarangarm P, London MS, Snowden SS, et al. Impact of pharmacist discharge medication therapy counseling and disease state education: Pharmacist assisting at routine medical discharge (project PhARMD) Am J Med Qual. 2013;28(4):292–300.
    1. Hesselink G, Schoonhoven L, Barach P, et al. Improving patient handovers from hospital to primary care: A systematic review. Ann Intern Med. 2012;157(6):417–428.
    1. Eaddy MT, Cook CL, O’Day K, Burch SP, Cantrell CR. How patient cost-sharing trends affect adherence and outcomes: A literature review. P T. 2012;37(1):45–55.
    1. Loeppke R, Taitel M, Haufle V, Parry T, Kessler RC, Jinnett K. Health and productivity as a business strategy: A multiemployer study. J Occup Environ Med. 2009;51(4):411–428.
    1. Morgan TM. The economic impact of wasted prescription medication in an outpatient population of older adults. J Fam Pract. 2001;50(9):779–781.
    1. Bain T. Public health implications of household pharmaceutical waste in the United States. Health Services Insights. 2010;(3):21.
    1. Benjamin RM. Medication adherence: Helping patients take their medicines as directed. Public Health Rep. 2012;127(1):2–3.
    1. Kronish IM, Ye S. Adherence to cardiovascular medications: Lessons learned and future directions. Prog Cardiovasc Dis. 2013;55(6):590–600.
    1. Esposito D, Bagchi AD, Verdier JM, Bencio DS, Kim MS. Medicaid beneficiaries with congestive heart failure: Association of medication adherence with health care use and costs. Am J Manag Care. 2009;15(7):437–445.
    1. Sun SX, Ye X, Lee KY, Dupclay L, Jr, Plauschinat C. Retrospective claims database analysis to determine relationship between renin-angiotensin system agents, rehospitalization, and health care costs in patients with heart failure or myocardial infarction. Clin Ther. 2008;30(Pt 2):2217–2227.
    1. Pittman DG, Chen W, Bowlin SJ, Foody JM. Adherence to statins, subsequent health care costs, and cardiovascular hospitalizations. Am J Cardiol. 2011;107(11):1662–1666.
    1. Wu J, Seiber E, Lacombe VA, Nahata MC, Balkrishnan R. Medical utilization and costs associated with statin adherence in medicaid enrollees with type 2 diabetes. Ann Pharmacother. 2011;45(3):342–349.
    1. Toy EL, Beaulieu NU, McHale JM, et al. Treatment of COPD: Relationships between daily dosing frequency, adherence, resource use, and costs. Respir Med. 2011;105(3):435–441.
    1. Simoni-Wastila L, Wei YJ, Qian J, et al. Association of chronic obstructive pulmonary disease maintenance medication adherence with all-cause hospitalization and spending in a medicare population. Am J Geriatr Pharmacother. 2012;10(3):201–210.
    1. Stuart BC, Simoni-Wastila L, Zuckerman IH, et al. Impact of maintenance therapy on hospitalization and expenditures for medicare beneficiaries with chronic obstructive pulmonary disease. Am J Geriatr Pharmacother. 2010;8(5):441–453.
    1. Balkrishnan R, Rajagopalan R, Camacho FT, et al. Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus: a longitudinal cohort study. Clin Ther. 2003 Nov;25(11):2958–2971.
    1. Cantrell CR, Eaddy MT, Shah MB, Regan TS, Sokol MC. Methods for evaluating patient adherence to antidepressant therapy: A real-world comparison of adherence and economic outcomes. Med Care. 2006;44(4):300–303.
    1. Eaddy MT, Druss BG, Sarnes MW, Regan TS, Frankum LE. Relationship of total health care charges to selective serotonin reuptake inhibitor utilization patterns including the length of antidepressant therapy – results from a managed care administrative claims database. J Manag Care Pharm. 2005;11(2):145–150.
    1. Robinson RL, Long SR, Chang S, et al. Higher costs and therapeutic factors associated with adherence to NCQA HEDIS antidepressant medication management measures: Analysis of administrative claims. J Manag Care Pharm. 2006;12(1):43–54.
    1. Salas M, Hughes D, Zuluaga A, Vardeva K, Lebmeier M. Costs of medication nonadherence in patients with diabetes mellitus: A systematic review and critical analysis of the literature. Value Health. 2009;12(6):915–922.
    1. Breitscheidel L, Stamenitis S, Dippel FW, Schoffski O. Economic impact of compliance to treatment with antidiabetes medication in type 2 diabetes mellitus: A review paper. J Med Econ. 2010;13(1):8–15.
    1. Egede LE, Gebregziabher M, Dismuke CE, et al. Medication nonadherence in diabetes: Longitudinal effects on costs and potential cost savings from improvement. Diabetes Care. 2012;35(12):2533–2539.
    1. Stuart B, Davidoff A, Lopert R, Shaffer T, Samantha Shoemaker J, Lloyd J. Does medication adherence lower medicare spending among beneficiaries with diabetes? Health Serv Res. 2011;46(4):1180–1199.
    1. Gardner EM, Maravi ME, Rietmeijer C, Davidson AJ, Burman WJ. The association of adherence to antiretroviral therapy with health care utilization and costs for medical care. Appl Health Econ Health Policy. 2008;6(2–3):145–155.
    1. Hirsch JD, Gonzales M, Rosenquist A, Miller TA, Gilmer TP, Best BM. Antiretroviral therapy adherence, medication use, and health care costs during 3 years of a community pharmacy medication therapy management program for medi-cal beneficiaries with HIV/AIDS. J Manag Care Pharm. 2011;17(3):213–223.
    1. Barnett PG, Chow A, Joyce VR, et al. Determinants of the cost of health services used by veterans with HIV. Med Care. 2011;49(9):848–856.
    1. Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: A systematic review. Ann Intern Med. 2012
    1. Krueger KP, Berger BA, Felkey B. Medication adherence and persistence: A comprehensive review. Adv Ther. 2005;22(4):313–356.
    1. Boskovic J, Leppee M, Culig J, Eric M. Patient self-reported adherence for the most common chronic medication therapy. Scand J Public Health. 2013;41(4):333–335.
    1. Barfod TS, Sorensen HT, Nielsen H, Rodkjaer L, Obel N. ‘Simply forgot’ is the most frequently stated reason for missed doses of HAART irrespective of degree of adherence. HIV Med. 2006;7(5):285–290.
    1. Boston Consulting Group The hidden epidemic: finding a cure for unfilled prescriptions and missed doses. 2003. [Accessed September 10, 2013]. Available from: .
    1. Kennedy J, Tuleu I, Mackay K. Unfilled prescriptions of medicare beneficiaries: Prevalence, reasons, and types of medicines prescribed. J Manag Care Pharm. 2008;14(6):553–560.
    1. Voils CI, Maciejewski ML, Hoyle RH, et al. Initial validation of a self-report measure of the extent of and reasons for medication nonadherence. Med Care. 2012;50(12):1013–1019.
    1. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: A meta-analysis. Med Care. 2009;47(8):826–834.
    1. Snipes SA, Sellers SL, Tafawa AO, Cooper LA, Fields JC, Bonham VL. Is race medically relevant? A qualitative study of physicians’ attitudes about the role of race in treatment decision-making. BMC Health Serv Res. 2011;11:183–6963.
    1. Brunton SA. Improving medication adherence in chronic disease management. J Fam Pract. 2011;60(4):S1–S8.
    1. Braithwaite S, Shirkhorshidian I, Jones K, Johnsrud M. The role of medication adherence in the US healthcare system. 2013. [Accessed September 10, 2013]. Available from: .
    1. Greene J, Hibbard JH. Why does patient activation matter? an examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med. 2012;27(5):520–526.
    1. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the patient activation measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–1026.
    1. Piette JD, Beard A, Rosland AM, McHorney CA. Beliefs that influence cost-related medication non-adherence among the “haves” and “have nots” with chronic diseases. Patient Prefer Adherence. 2011;5:389–396.
    1. Choudhry NK, Avorn J, Glynn RJ, et al. Full coverage for preventive medications after myocardial infarction. N Engl J Med. 2011;365(22):2088–2097.
    1. Community Preventive Services Task Force Annual report to congress. 2013. [Accessed September 21, 2013]. Available from: .
    1. DeFulio A, Silverman K. The use of incentives to reinforce medication adherence. Prev Med. 2012;55(Suppl):S86–S94.
    1. Kimmel SE, Troxel AB. Novel incentive-based approaches to adherence. Clin Trials. 2012;9(6):689–695.
    1. Volpp KG, Loewenstein G, Troxel AB, et al. A test of financial incentives to improve warfarin adherence. BMC Health Serv Res. 2008;8:272.
    1. Kimmel SE, Troxel AB, Loewenstein G, et al. Randomized trial of lottery-based incentives to improve warfarin adherence. Am Heart J. 2012;164(2):268–274.
    1. Rosenthal TC. The medical home: Growing evidence to support a new approach to primary care. J Am Board Fam Med. 2008;21(5):427–440.
    1. Smith M, Bates DW, Bodenheimer T, Cleary PD. Why pharmacists belong in the medical home. Health Aff (Millwood) 2010;29(5):906–913.
    1. Lee-Wilson CMA. Establishing a medication therapy management (MTM) practice: Obtaining compensation for clinical services. Maryland Pharmacist. 2011:3.
    1. National Conference of State Legislatures Medication therapy management: Pharmaceutical safety and savings. National Conference of State Legislatures Web site. [Accessed December 19, 2012]. .
    1. Kucukarslan SN, Hagan AM, Shimp LA, Gaither CA, Lewis NJ. Integrating medication therapy management in the primary care medical home: A review of randomized controlled trials. Am J Health Syst Pharm. 2011;68(4):335–345.
    1. E-prescribing shown to improve outcomes, save billions. Study quantifies relationship between e-prescribing and medication adherence, with potential savings of $140 billion over the next 10 years. Health Manag Technol. 2012;33(4):22–23.
    1. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501–504.
    1. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: Scientific review. JAMA. 2002;288(22):2868–2879.
    1. Granger BB, Bosworth HB. Medication adherence: Emerging use of technology. Curr Opin Cardiol. 2011;26(4):279–287.
    1. Cooper LA, Roter DL, Carson KA, et al. A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients. J Gen Intern Med. 2011;26(11):1297–1304.
    1. Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: A systematic review. Arch Intern Med. 2007;167(6):540–550.
    1. Golay A. Pharmacoeconomic aspects of poor adherence: can better adherence reduce healthcare costs? J Med Econ. 2011;14(5):594–608.

Source: PubMed

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