Prevalence Of Cost-related Nonadherence Research Articles

Abstract 11520: Cost-Related Medication Nonadherence in Adults with Diabetes Mellitus in the United States

Background: Health-related expenditures due to diabetes mellitus (DM) are rising in the US. Medication nonadherence is associated with worse health outcomes, particularly among individuals with DM who require uninterrupted treatment. We sought to determine whether patients with DM in the US report cost-related nonadherence (CRN), a potential consequence of rising drug costs. Methods: We used the National Health Interview Survey (2013-18), a nationally representative study, to identify participants with and without self-reported DM. Participants were considered to have experienced CRN if during the preceding year they reported skipping doses, taking less medication, or delaying filling a prescription to save money. Results: Of the 20,326 participants with DM, a weighted 14% (or 3 million annually) experienced CRN, including 9.5% skipping doses, 9.9% taking less medicine, and 11.8% delaying prescription filling to save money. Compared to those without DM (N=145,186), participants with DM reported a higher prevalence of CRN, with the largest differences being observed among non-elderly adults (Figure). Among non-elderly adults with DM, a weighted 19.4% (or 2.3 million annually) reported CRN. In multivariable logistic regression models, the main drivers of CRN among participants with DM were lack of insurance (OR 4.34, 95% CI 3.49, 5.39), younger age (OR 3.43, 95% CI 2.65, 4.44), low income (OR 1.82, 95% CI 1.58, 2.09), use of insulin (OR 1.19, 95% CI 1.04, 1.35), and unfavorable risk factor profile (OR 1.53, 95% CI 1.21, 1.93) (Table). Conclusion: In the US, 1 in 7 adults with DM reported CRN, and the burden was highest among non-elderly adults. Cost represents a serious barrier for therapy adherence among individuals with DM in the US, particularly among the most vulnerable. Removing financial barriers to accessing medications may improve adherence to essential therapies among individuals with DM, and ultimately improving outcomes.

Medication nonadherence and patient cost responsibility for rural and urban cancer survivors.

4 Background: Little is known about the specific out-of-pocket costs which may lead to prescription nonadherence in older cancer survivors, and how patterns may differ for those living in rural areas. This study quantified patient costs overall and by residence for older cancer survivors who did and did not report cost-related prescription nonadherence. Methods: This retrospective cohort study used data from the Surveillance, Epidemiology, and End Results Program, Medicare claims, and the Consumer Assessment of Healthcare Providers and Systems survey linked data resource (SEER-CAHPS) from 2007-2015. Older cancer survivors self-reported cost-related prescription nonadherence in the prior six months. Patient cost responsibility (deductibles, coinsurance, copayments) was summed for all medical care received in the year prior to survey. Differences in patient cost responsibility by cost-related adherence was estimated using gamma generalized linear models adjusted for patient age, race, sex, education, dual Medicaid enrollment status, residence, comorbidity count, cancer type, stage, and phase of care. Models stratified by urban/rural residence as designated by Rural-Urban continuum codes assessed effect modification. Results: Of 11,829 older adult survivors of prostate (37%), breast (32%), colorectal (14%), gynecologic (10%), or lung (6%) cancer, 12% reported any cost-related prescription nonadherence in the prior year. Median age of survivors was 76 (interquartile range [IQR] 71-82), 15% had less than a high school degree, 59% had at least one non-cancer comorbidity, and 16% had ever been dual eligible. Prevalence of cost-related nonadherence was similar by patient characteristics. Median cost responsibility in the year prior to survey was $1,529 (IQR $744-$2,959) for patients reporting nonadherence and $1,123 (IQR $572-$2,362) for those reporting adherence. In adjusted models, patients reporting nonadherence had $656 higher patient cost responsibility in the year prior (95% CI $564-$760) compared to those reporting adherence. Approximately half of the difference in cost was outpatient spending (β = $277, 95% CI $210-$359). Differences in cost responsibility for patients reporting nonadherence compared to adherence were smaller for patients residing in rural areas (18% of respondents; β = $341, 95% CI $177-$564) compared to those residing in urban areas (82% of respondents; β = $715, 95% CI $613-$830). Conclusions: Compared to those reporting adherence, cost-related prescription nonadherence was associated with higher health care cost responsibility in cancer survivors. Furthermore, prescription adherence decisions may be more cost-sensitive for patients living in rural compared to urban areas. Interventions to address out-of-pocket health care costs, particularly for rural cancer survivors, could aid in increased prescription adherence and subsequent health outcomes.

Cost-related nonadherence for prescription medications: a cross-sectional study in Jordan

ABSTRACT Background Cost-related nonadherence to medications is a commonly encountered problem posed by many patients, and specifically among elderly patients who use multiple chronic medications. This study aims to explore the prevalence of medication cost-related nonadherence and its predictors in Jordan. Method A cross-sectional study was conducted between February 2019 and May 2019 in Jordan. The CRN questionnaire was used as a measure to assess the prevalence of cost-related nonadherence. Logistic regression was used to determine predictors of medication cost-related nonadherence. Results The prevalence rate of CRN was 29.6% (95% CI: 27.0–32.3). Participants who are married or widowed were found to have higher odds of being non-adherent due to medication costs, with an odds ratio of 1.55 (95%CI: 1.19–2.00) and 1.95 (95%CI: 1.20–3.15), respectively. Lower educational level was associated with higher odds of being non-adherent 1.95 (95%CI: 1.25–3.05). Being retired was associated with higher odds of being non-adherent (2.20 (95%CI: 1.49–3.27)). Conclusion Cost-related nonadherence is a common problem in Jordan and was most prevalent among those with hypertension and diabetes mellitus, low-income, and low levels of education. Our findings could help in developing interventions to improve cost-related medication nonadherence in developing countries.

Medication affordability gains following Medicare Part D are eroding among elderly with multiple chronic conditions.

Elderly Americans, especially those with multiple chronic conditions, face difficulties paying for prescriptions, which results in worse adherence to and discontinuation of therapy, called cost-related medication nonadherence. Medicare Part D, implemented in January2006, was supposed to address issues of affordability for prescriptions. We investigated whether the gains in medication affordability attributable to Part D persisted during the six years that followed its implementation. Overall, we found continued incremental improvements in medication affordability in the period 2007-09 that eroded during the period 2009-11. Among elderly beneficiaries with four or more chronic conditions, we observed an increase in the prevalence of cost-related nonadherence from 14.4percent in 2009 to 17.0percent in 2011, reversing previous downward trends. Similarly, the prevalence among the sickest elderly of forgoing basic needs to purchase medicines decreased from 8.7percent in 2007 to 6.8percent in 2009 but rose to 10.2percent in 2011. Our findings highlight the need for targeted policy efforts to alleviate the persistent burden of drug treatment costs on this vulnerable population.