The Risk and Cost of Medication Non Adherence In Hypertensive and Diabetic Patients

By Dr. Batami Sadan

A leading study on the  “Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost” [1] published peer-reviewed journal Refereed journal Academia A professional journal that only publishes articles subjected to a rigorous peer validity review process. Cf Throwaway journal. by the American Public Health Association was based on a sample of over 137,000 patients under the age of 65 with diabetes, high cholesterol, hypertension, or congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. . This study was one of the first to demonstrate the savings generated by medication adherence for these prevalent chronic medical conditions.

The study found that the least compliant diabetes patients were more than twice as likely to be hospitalized compared to those who were most compliant, and their total health care costs were nearly double, as well. For diabetes patients, every additional dollar spent on medication saved $7 in medical costs. Diabetes patients who are highly compliant with their treatment programs have a 13 percent hospitalization risk for a diabetes- related problem, but patients with low compliance have more than twice the risk at 30 percent. The combined drug and medical costs for the most compliant patients average $4,570, which is almost 50 percent below the $8,867 cost for the least compliant group. 

High Cholesterol and Hypertension
The same article also analyzed Hypertensive and Hypercholesterolemia (high cholesterol) patients. The medical cost savings were $5.10 for each additional dollar spent on medications for high cholesterol, and $3.98 for every dollar spent on prescription drugs for patients with high blood pressure. The difference among patients with cholesterol problems was more significant in terms of cost then risk since a hospital stay for a cardiovascular problem, such as a heart attack or stroke, is expensive. The hospitalization risk of the most compliant patients is 12 percent versus 15 percent in the least compliant group. However, the total health care cost is $3,924 for the most compliant group, compared with $6,888 in the least compliant group.

In a recent review article “Adherence and Healthcare Cost” published in 2014 by Dove Press Journal of Risk Management and Healthcare policy [2] the study indicated that “between $100 and $300 billion of avoidable health care costs have been attributed to nonadherence in the US annually, representing 3% to 10% of total US health care costs.” 

Another interesting finding was quoted in the article: “among patients, forgetting is the most frequently reported reason for nonadherence. In a survey of 10,000 patients, the most common reported reason for missing medications was forgetfulness (24%), followed by perceived side effects (20%), high drug costs (17%), and perception that a prescribed medication would have little effect on their disease (14%)” 

The article suggested selected strategies for improving medication adherence like: improving patient and care provider relationship, simplifying medication regiments, educating patients and offering automated alerts and remote monitoring.

The World Health Organization stated that “Failure to take prescribed medicine for chronic diseases is a massive, world-wide problem… Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments”[3].