A spoonful of compliance helps health costs go down
August 1, 2005
New research conducted by Medco Health Solutions shows that adherence to medication therapy averages only 50% to 65% for common chronic conditions, costing the American health care system as much as $300 billion.
It seems a sensible premise - chronically ill patients who adhere to their prescription treatment plans are healthier and save themselves and their employers valuable health care dollars. However, new research conducted by Medco Health Solutions shows that adherence to medication therapy averages only 50% to 65% for common chronic conditions, costing the American health care system as much as $300 billion.
That's dismaying, given compliance's high payoff. Medco examined more than 137,000 patients with diabetes, high cholesterol, hypertension or congestive heart failure and found that, in spite of steadily rising prescription drug prices, the money spent on medication treatments led to substantial savings when the costs of adherence to prescription drug therapy were compared to the costs of hospitalization and medical treatments.
For example, for diabetes patients, every additional dollar spent on medication saved $7 in medical costs. 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.
Patients in the study were categorized into groups based on their level of prescription medication compliance, and their drug and medical costs were tracked over the course of the following year. Medical costs included the costs of doctor visits, emergency room visits and hospitalizations.
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, Medco researchers found. Diabetes patients who are highly compliant with their treatment programs have a 13% hospitalization risk for a diabetes-related problem, but patients with low compliance have more than twice the risk at 30%. 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.
Among patients with high cholesterol, the hospitalization risk of the most-compliant patients is 12%, versus 15% in the least compliant group. The total health care cost is $3,924 for the most compliant group, compared with $6,888 in the least compliant group.
The study also looked at medical expenses that included cases in which patients have more than one ailment. Better compliance with drug therapy helped reduce the risk of being hospitalized for any medical condition, and it reduced the overall costs for a patient's health care. The least compliant group of diabetics had on average $16,498 in total medical and drug costs compared with $8,886 for the most compliant group. Among patients with high blood cholesterol, the total medical and drug costs were $10,916 in the least compliant group versus $6,752 in the most compliant category.
Noncompliance roots, remedies
Reasons for poor medication compliance include cost, side effects, forgetfulness or a lack of symptoms that lead patients to prematurely stop taking medications. Patients with chronic conditions that show no visible symptoms, such as high cholesterol or high blood pressure, can think they are fine and don't require medication, even as their health deteriorates.
"Healthcare professionals, including pharmacists and PBMs, can play an important role in encouraging medication compliance," says Dr. Robert Epstein, a co-author of the study and Medco's chief medical officer. "Drugs have become increasingly complex and people are being prescribed more of them, which places greater demands on healthcare providers to educate patients and take proactive measures to ensure proper medication use."
Epstein also noted that going forward, generics will continue to play a key role in assisting patients with compliance due to cost concerns. Drugs with total U.S. sales of approximately $35 billion could lose patent protection over the next three years, making way for much more cost-effective choices in a variety of therapeutic categories including hypertension, diabetes and high cholesterol medications.
"This research hammers home the dangers and the expense of not following a treatment regimen," Epstein says. "Increased medication compliance for chronic conditions can significantly cut medical costs and keep patients out of the hospital. Clearly it's important to reduce the need for hospitalization, both from a clinical and a cost standpoint."
Full results of the study, "Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost," have been published in the June issue of Medical Care, a journal by the American Public Health Association.
Compliance counts
Better compliance with drug therapy reduced overall costs for a patient's health care. Below are the prescription and medical costs for least compliant patients vs. most compliant.
Diabetes
Least compliant $16,498
Most compliant $8,886
High cholesterol
Least compliant $10,916
Most compliant $6,752
Source: Medco Health Solutions, 2005.
Bitter pill to swallow
Individuals with diabetes and high cholesterol can generate significant health care savings just by taking their medications as prescribed. Dollars spent on medications compared to dollars saved in health costs:
Diabetes
$1 spent, $7 saved
High cholesterol
$1 spent, $5.10 saved
Hypertension
$1 spent, $3.98 saved.
Source: Medco Health Solutions, 2005. - K.M.B.
|
