One in Eight Patients with Atherosclerotic Cardiac Disease Experience Cost-Related Medication Nonadherence

Mandana Chitsazan, M.D.
By Mandana Chitsazan, M.D. on

One in eight patients with atherosclerotic cardiovascular disease reports medication nonadherence due to cost, according to a nationally representative survey of more than 14,000 US adults. The findings of the study led by Dr. Rohan Khera (University of Texas Southwestern Medical Center, Dallas, US) was recently published in Circulation.

Previous studies estimate that nearly half of Americans are not compliant with their prescribed medications. Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death and disability in the United States and adherence to medications is necessary in order to lower the risk of adverse patient outcomes and financial burden on the health care system. Medication nonadherence is multifactorial and the study by Dr. Khera et al tried to investigate cost-related medication non-adherence (CRN) among US adults with ASCVD. 

The investigators used data from NHIS (National Health Interview Survey) from 2013 to 2017. Participants with ASCVD who skipped doses, took less medication, or delayed prescription fill to save money in the preceding 12 months were considered to have encountered CRN. They also assessed whether the patients have asked their physician for a cheaper medication, imported medications from other countries to save money, or tried alternative therapies to save money. 

Of the 14,279 participants, 1774 individuals reported CRN, corresponding to 12.6% of US adults with ASCVD. It represents an estimated 2.2 million (95% CI, 2.1–2.4) patients per year who experienced CRN in the study time frame. Overall, an estimated 1.5 million (95% CI, 1.4– 1.6 million) patients missed doses of medications to save money, 1.6 million (95%CI, 1.5-1.7 million) patients took fewer doses to save money, and 1.9 million (95% CI, 1.7–2 million) delayed filling their prescriptions to save money. 

Cost-related medication nonadherence is frequent in many vulnerable Americans with ASCVD. Health policy interventions would need to urgently focus attention on targeting drugs costs as an important avenue to improve adherence to medications and to reduce future needs of healthcare services”, the investigators concluded.

Age less than 65 years, female sex, low family income, lack of health insurance, and high comorbidity burden were independently associated with CRN. Participants experiencing CRN were 10.8 fold more likely to ask their physician for cheaper medications and 8.9 fold more likely to use nonprescription, alternative therapies to save money. Notably, there were no significant differences in CRN by race/ethnicity.

The results have implications for health policy. This study highlights an urgent need to target low-income patients and widen health insurance coverage. Physicians are also encouraged to substitute generic medications whenever possible to enhance medication adherence in vulnerable patients. 

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