1.5 million US patients miss doses of ASCVD medication due to cost
Click Here to Manage Email Alerts
Approximately 2.2 million, or 13%, of patients with atherosclerotic CVD experience cost-related nonadherence to prescribed medication in the U.S. and approximately 9% take lower than the prescribed dose, according to findings published in Circulation.
Using data from the National Health Interview Survey (2013-2017), researchers observed that a weighted 12.6%, or 2.2 million, of patients with ASCVD reported cost-related nonadherence to prescribed medication, with an estimated 9%, or 1.5 million, of patients missing doses to save money.
Moreover, approximately 9%, or 1.6 million, of patients with ASCVD took less than the prescribed dose, and about 11%, or 1.9 million, of patients reported they delayed filling prescriptions with the intention of saving money.
“In this study, we specifically wanted to understand the scope of medication noncompliance as well as factors driving nonadherence due to costs that may help identify patient subgroups who may be specifically focused on interventions aimed at mitigating these effects,” Khurram Nasir, MD, MPH, MSc, chief of the division of cardiovascular prevention and wellness at Houston Methodist DeBakey Heart & Vascular Center and co-director of the Center for Outcomes Research, told Healio. “A better understanding of this phenomenon is likely going to facilitate discussion of the ongoing political debate on best policies to limit these unintended consequences of rising health care costs.”
In other findings, rates of cost-related nonadherence decreased from 15% in 2013 to 11% in 2016 (P < .001), with a nonsignificant change from 2016 to 2017.
“These findings have strong implications and suggest that the current for-profit private insurance system is failing those who it was intended to protect from financial risk,” Nasir told Healio. “We feel that our findings show that policymakers need to engage stakeholders and seek alternates; public options such as ‘Medicare for All’ or Medicare for high-risk groups, such as those with cardiovascular disease, does not seem too unrealistic in these circumstances.”
Specific demographics
According to the study, patients younger than 65 years with ASCVD were, compared patients with ASCVD aged at least 65 years, three times more likely to report taking fewer medication doses to save money (15.2% vs. 4.8%), taking fewer medications than prescribed (15.5% vs. 5.1%) and delaying refilling prescriptions (18.3% vs. 4.7%).
Additionally, patients with cost-related nonadherence were more likely than those without it to pursue alternative therapies for the treatment of their ASCVD (OR = 8.9; 95% CI, 6.6-12.1) as well as request lower-cost medications (OR = 10.8; 95% CI, 9-12.9).
“Mere pointing to the scope of the problem will not suffice. As cardiologists, we can do much more in the interim,” Nasir told Healio. “First, we need to play our role in taking charge in having these dogmatic conversations with our patients. Second, we need to systematically screen patients at risk for financial hardship and tailoring management to help find alternatives for our patients. Fortunately, there are quite a few such options available for managing patients with cardiovascular disease. Third, we also need to play a major role in influencing national health care policies such as capping out-of-pocket expenses for low-income families and ensuring price transparency to influence physician prescribing behaviors and patient informed choices. Importantly, we need to focus on utilization of generic medications wherever possible, but also not to forget that it’s not only the cost of medications, but also the cumulative financial burden, as the overall costs and difficulty paying bills can also impede their treatment. Fourth, we need to play an active role in working with our local health system and community financial assistance support programs to provide financial assistance to those who need it the most.”
Methods and study design
Researchers used a nationally representative survey of U.S. adults to identify 14,279 patients with a reported history of ASCVD and performed an analysis to obtain national estimates. According to the study, patients experienced cost-related nonadherence if in the previous 12 months they reported skipping doses, taking less medication or delaying filling a prescription to save money.
“Our study was unable to detail which specific medications patients were using and more likely to result in cost-related noncompliance,” Nasir told Healio. “More importantly, we did not know whether patients who reported to be noncompliant if they had worse outcomes and downstream resource utilization.
“There is a dearth of screening tools for financial toxicity for patients with cardiovascular heart disease; we are currently looking at tools that can easily be implemented in the real world allowing us appropriate interventions to reduce the risk of these unintended challenges faced by millions of patients due to high cost of medical care,” Nasir said.
Insurance access crucial
“Interestingly, there were no significant differences in cost-related medication adherence by race/ethnicity or education. This suggests that focusing efforts on low-income groups and increasing access to insurance, which cut across large groups of patient populations, might be highly beneficial,” William Borden, MD, FAHA, associate professor of medicine and health policy at George Washington University and chair of the American Heart Association Council on Quality of Care and Outcomes Research, wrote in an editorial published on the AHA’s Center for Health Metrics and Evaluation web site. “As we pursue health equity for all, it’s imperative that individuals and communities have access to care and resources — including medications to manage heart disease.” – by Scott Buzby
Disclosures: Healio could not confirm Borden’s relevant financial disclosures at the time of publication. Nasir and the other authors report no relevant financial disclosures.
Perspective
Back to Top
L. Samuel Wann, MD
Nasir and colleagues provide important documentation that the cost of medication is an important barrier to adherence with medical treatment of chronic ASCVD, particularly in patients with lower incomes and/or no insurance. Perhaps surprisingly, nonadherence did not correlate with ethnicity or level of education and women were found to be more vulnerable to the cost of medications than men. Nonadherence to chronic medical therapy is a major problem encountered with all our patients, not just those with lower incomes. An important adjunct to advocacy for health policy targeting drug costs is the need for more emphasis by our health care system on intensive outpatient management of chronic CVD, including continuous interaction between patients and members of the health care team outside the hospital and outside the traditional physician office setting, monitoring and promoting healthy lifestyles, diet, exercise and smoking cessation as well as medication compliance.
Read more about
Click Here to Manage Email Alerts