Timely and continuous use of prescription medicines as recommended by a healthcare provider is key to effective disease management, particularly for chronic conditions. Yet, medicines are frequently not used as directed, leading to poor clinical outcomes, avoidable health care costs, and lost productivity.  Closing the adherence gap can improve the quality of healthcare, encourage better chronic care management, and promote better patient outcomes. Below are some important adherence facts.

The Economic Burden of Chronic Disease is Substantial

  • Health care spending is highly concentrated. The top 5% of healthcare users based on total healthcare expenditures account for over half of all health care expenditures. Expenditures in this population are more than 10-fold higher compared with the full population. (1)
  • About one half of adults or 117 million have one chronic condition and almost one-third have two or more. In 2010, eighty-six percent of all health care spending was for treating people with one or more chronic medical conditions. (2)
  • Diabetes is estimated to cost $245 billion in a single year and care for people with diagnosed diabetes accounts for more than 1 in 5 health care dollars in the U.S. Today nearly half of adults in the U.S. have diabetes or pre-diabetes (including 12-14% of adults with diabetes). (3-4)
  • Alzheimer’s creates an enormous strain on families and the health care system. Total healthcare expenditures for people with dementia was 57% greater ($287,038) than the costs associated with death from cancer and heart disease in the last 5 years of life.The costs of dementia come in the form of family and unpaid caregiver support. In 2011, nearly 6 million caregivers were assisting older adults with dementia and provided 532 million hours of help per month, or over 6 billion hours. (5-6)

Use of Recommended Medications to Treat Chronic Disease is Poor 

  • Among chronic disease patients, approximately 50% do not take their medications as prescribed.In fact, more than one quarter of newly written prescriptions are never brought to the pharmacy to be filled, including those for high blood pressure, diabetes, and high cholesterol. (7-9)
  • Medicines are prescribed only two-thirds as often as indicated and failure to prescribe a necessary medicine is a more common quality problem than inappropriate prescribing. Among elderly patients, underuse of recommended medicines outweighs overuse by about 17 to 1. (10)
  • Nearly one-third of heart attack patients are not persistent with their prescribed medications by 6 months. High-risk heart attack patients have a lower likelihood of persistently taking prescribed medications compared to low risk patients post discharge. (11-12)
  • Less than half of elderly diabetic patients with inadequately controlled diabetes received treatment intensification. (13)

Better Adherence to Medicines Can Improve Health Outcomes and Reduce Healthcare Spending 

  • Improved medication adherence among patients with diabetes could result in over 1 million avoided emergency department visits and hospitalizations annually, for potential savings of $8.3 billion each year. (14)
  • Adherent employees with diabetes, hypertension, dyslipidemia, and asthma/COPD experience between 2 and 7 fewer days absent from work and between 1 and 5 fewer days on short-term disability than those who were not adherent. (15)
  • Medicaid beneficiaries with low adherence had 1.8 times higher risk of acute CVD events compared to those with higher adherence. The increase in medication cost from higher AHM adherence was offset solely by reduced Medicaid spending on acute CVD events. (16)
  • Among Medicare Part D enrollees with diabetes, heart failure, and COPD, those who were consistently adherence had lower medical and hospital costs than  non-adherence beneficiaries, up to $840 per month. (17)

References

1. Daryl Pritchard, Allison Petrilla, Shawn Hallinan, Donald H. Taylor Jr.,Vernon F. Schabert, and Robert W. Dubois. What Contributes Most to High Health Care Costs? Health Care Spending in High Resource Patients. Journal of Managed Care & Specialty Pharmacy 2016 22:2, 102-109 2. Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook. AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014. 3.  American Diabetes Association.” Economic Costs of Diabetes in the US in 2012.”Diabetes Care 36.4 (2013):1033-1046. 4. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012.JAMA. 2015;314(10):1021-1029. 5. Kelly et al. The Burden of Health Care Costs for Patients with Dementia in the Last 5 Years of Life. Ann Intern Med. 2015;163:729-736. 6. Kasper, J. D., Freedman, V. A., Spillman, B. C., & Wolff, J. L. (2015). The Disproportionate Impact Of Dementia On Family And Unpaid Caregiving To Older Adults. Health Affairs, 34(10), 1642-1649. 7. R.B. Haynes et al. “Interventions for Enhancing Medication Adherence.” Cochrane Database System Review. 2008. 8. Rand Corporation.(2004). Quality of health care received by older adults. http://www.rand.org/pubs/research_briefs/RB9051.html. Accessed Aug 10, 2015. 9. M.A. Fischer et al. “Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions.” Journal of General Intern Medicine. 25 no. 4 (2010): 284-90. 10.T.  Higashi et al. “The Quality of Pharmacologic Care for Vulnerable Older Patients.”  Annals of Internal Medicine 140 no. 9 (2004): 714-20. 11. Mathews et al. Persistence with secondary prevention medications after acute MI: Insights from the TRANSLATE-ACS study. AmHeart J. 2015Jul;170(1): 62-9. 12. Shore S et al. Heart. Longitudinal persistence with secondary prevention therapies relative to patient risk after MI. 101(10):800-7, 2015 May 15. 13.  Ajmera, M., Raval, A., Zhou, S., Wei, W., Bhattacharya, R., Pan, C., & Sambamoorthi, U. (2015). A Real-World Observational Study of Time to Treatment Intensification Among Elderly Patients with Inadequately Controlled Type 2 Diabetes Mellitus. Journal of managed care & specialty pharmacy, 21(12), 1184-1193. 14. A. Jha, et al. Greater Adherence to Diabetes Drugs is Linked to Less Hospital Use and Could Save Nearly $5 Billion Annually. Health Affairs 31 no. 8 (2012): 1836-46. 15. G. Carls et al. “Impact of Medication Adherence on Absenteeism and Short-Term Disability for Five Chronic Diseases.” J Occup Environ Med 54 no. 7 (2012): 792-805. 16.  Zhuo et al. Association of Antihypertensive Medication Adherence with Healthcare Use and Medicaid Expenditures for Acute Cardiovascular Events. Medical Care, Feb 2016. 17. B Stuart et al. Increasing Medicare Part D Enrollment In Medication Therapy Management Could Improve Health And Lower Costs. Health Affairs vol. 32 no. 7 (2013): 1212-1220.