Does Nonadherence Really Cost the Health Care System $300 Billion Annually?
Timothy Dy Aungst, PharmD, is an associate professor of pharmacy practice at MCPHS University. He graduated from Wilkes University Nesbitt School of Pharmacy and completed a PGY-1 Pharmacy Practice Residency at St. Luke's University Hospital, and then a Clinical Geriatric Fellowship at MCPHS University. He is passionate about the rise of technology in health care and its application to pharmacy. He has published primarily on the role of mobile technology and mHealth, and made multiple national and international presentations on those topics. He blogs at TheDigitalApothecary.com, is a Co-Host of FurtureDose.tech a podcast part of the Pharmacy Podcast Network, and you can find him on Twitter @TDAungst.
What role do pharmacists play in medication optimization to help save money?
It is often said that medication nonadherence in the United States costs the health care system $300 billion annually, particularly by companies invested in improving adherence.
After all, health care is a business, and nothing sounds more appealing to investors than a large untapped market. But where did that $300 billion really come from?
In 2012, a review was published in The Annals of Internal Medicine titled "Interventions to Improve Adherence to Self-Administered Medications for Chronic Diseases in the United States: A Systematic Review."1 The review did not analyze the cost of nonadherence. Rather, it identified papers that had addressed it, which included other reviews and related studies. The actual statement from the researchers is that "nonadherence has been estimated to cost the US health care system between $100 billion and $289 billion annually." So, a lowball estimate was $100 billion at the time. Considering that the studies mentioned were published all in the early 2000s with the most recent being 2009, it seems probable that even that estimate may be slightly off.
For that reason, a recent paper published in The Annals of Pharmacotherapy titled "Cost of Prescription Drug-Related Morbidity and Mortality" caught my attention, as it appeared to be an update of the cost of medication nonadherence and associated items.2 The research was aimed at updating "the estimated cost of drug-related morbidity and mortality resulting from nonoptimized medication therapy."
Before getting into the researchers' methods and results, 1 thing that the authors mentioned in their introduction is worth noting: "Although widely misdescribed in the published literature and policy documents as the cost associated with 'patient nonadherence to medications,' this estimate and the preceding estimates actually reflect medical resource utilization caused by [treatment failures (TF)] and [new medical problems] that arise from nonoptimized medication use. Nonadherence to the indicated medication regimen is just 1 of multiple potential causal factors leading to a TF, resulting in downstream health services use."
This was a new one. The fact is that many people assume that the $300 billion is the result of nonadherence when it would be better to say that the cost is related to the entire range of inappropriate medication use in the United States. The authors contend that nonoptimized medication therapy may lead to more care and possibly new medical problems needing further treatment. Nonadherence is a factor, but other factors play a role in the cost of medication use. So, the spiraling cost is related to doctor visits, hospital admissions, the cost of medications themselves, etc. The authors went back and analyzed much of the past data using previous methods to estimate costs in dollars and reflect inflation for 2016 prices.
The results? "The estimated annual cost of prescription drug-related morbidity and mortality resulting from nonoptimized medication therapy was $528.4 billion in 2016 US dollars" with a low end of $495.3 billion and high end of $672.7 billion. That is a lot of money. Also, the authors estimated that nonoptimized drug therapy results in about 275,689 deaths per year. This has huge implications and gives more credence to companies that are tackling medication issues in the United States.
Pharmacists can play a role both in adherence and the clinical ramifications. The authors discussed the implication of a better service whereby a comprehensive medication management system could help drive down these costs. Medication therapy management has been around for some time. But it has had immense difficulty taking off. Costs can be a considerable implication, and these data can be leveraged to encourage companies to tackle this issue to a greater extent.
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;157(11):785-95.
2. Watanabe JH, Mcinnis T, Hirsch JD. Cost of prescription drug-related morbidity and mortality. Ann Pharmacother.
1060028018765159. doi: 10.1177/1060028018765159.