Medication adherence is the extent to which the patient follows the doctor’s instructions while consuming the prescribed medication. It is one of the most crucial factors for the success of any treatment plan. WHO describes adherence as “the degree to which the person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes – corresponds with the agreed recommendations from a health care provider.”1 The extent of poor medication adherence depends on factors such as patient characteristics, diseases, affordability of treatment, and coverage by health insurance. It is a complex behavioural problem, with multiple factors2 causing it.

The problem of medication non-adherence is larger than one can anticipate. As per various studies3, more than 50% of patients do not adhere to their medication. Poor medication adherence is invariably associated with poor treatment outcomes, and also has other adverse implications –personal, physiological, and psychological, all of which culminate to produce adverse financial implications.

The financial implications of poor medication adherence are observed to form a vicious cycle4, beginning with poor medication adherence, which lead to poor health outcomes. As a result, the healthcare service utilization is increased. This puts a strain on the healthcare sector, leading to increase in healthcare costs; these costs are ultimately passed on to the patient. This in turn leads to costlier medicines (among other things), causing reduced access to medicines by the patients, which again causes poor medication adherence. And the vicious cycle continues, thereby affecting everyone involved – the patient, the physician and the healthcare economy.

The implications of financial loss due to poor medication adherence is far beyond just monetary losses. It involves costs of potential harm to the patients, eroded revenues for the pharmaceuticals and added strain to the healthcare systems and society. The financial impact caused due to poor adherence can be described under various headings:

  1. Increased medical costs: Poor medication adherence can convert a ‘manageable’ disease into a ‘complicated disease’, which may need hospitalization, adding to higher treatment costs. Thus, poor adherence increases creates a burden on patients’ finances. Studies have shown that risk of hospitalization was higher in non-adherent patients suffering from chronic diseases as compared to general population.
    The additional costs incurred due to worsened health conditions include ambulance rides to emergency rooms, high-end diagnostic tests and pharmacy expenses due to therapy intensification, increased hospital stays, intensive care and even surgeries. Studies5 estimate the medical costs due to poor adherence annually to be around $300 billion.The increased ‘out-of-pocket expenditure’ have known to push an individual towards medical debts. Furthermore, hospitalization leads to sick leaves, less productivity at work due to poor health, loss of salary and possibly layoffs.
  2. Impact on the pharmaceutical industry: Poor medication adherence leads to lower drug sales. The global pharmaceutical market is estimated to suffer revenue loss of $500 billion annually due medication non-adherence.6
    Next, poor outcomes due to poor medication adherence can be misinterpreted as the medication not working as intended. This can have a profound negative impact on the perceived brand value of the company. This may lead to the physician switching over to another medication, which could have potential negative impact on the patient in terms of adverse effects and cost. This may also have an unfavourable impact on patient retention with the healthcare provider, pharmaceutical company, and the hospital.
  3. Impact on healthcare delivery system: Complications and comorbidities arising out of poor medication adherence lead to increased healthcare service utilization at hospitals. This not only increase the per-patient expenditure in hospitals, but also puts a strain on the healthcare workers. In turn, this leads to higher pay-outs by insurance companies to the insurers.
    Increased morbidity due to poor adherence is also a public health concern. Poor adherence to medication can convert an easily manageable condition, for which the services of trained nurses/ doctors were not required, into a ‘complicated’ condition, that requires the effort of the healthcare providers. Patients that can be easily managed at outpatient clinics with medications, or even through telehealth, end up getting hospitalized due to poor adherence, straining an already burdened system, consuming services that otherwise would have served another set of population.
  4. Impact on Quality of Life: Following lifestyle changes and a disciplined treatment regimen is essential in the management of most of the chronic diseases. While life-style choices are often hard to maintain, ensuring optimal medication adherence is the only way to ensure treatment success and lower morbidity and mortality. Poor treatment adherence can lead to lower quality of life, which in turn increases the cost of healthcare.
    The progression of otherwise controllable disease due to poor adherence may cost the patient’s life. Estimates by the US CDC in 20147 show that approximately 125,000 lives per year are lost, in US alone8, due to medication non-adherence,
    The indirect costs associated with premature deaths, affecting work-force productivity are borne by the immediate associates of the deceased.
    To conclude, poor medication adherence is a ‘silent problem’, and a significantly increases healthcare costs, often undetected. The most startling aspect about this occurrence is that the entire sequence of events can be easily prevented, just by ensuring that the patient adheres to the medication instructions as given by the doctor. Thus, creating novel, interesting, and effective strategies to combat adherence barriers is essential to prevent the cost escalation. Better communication, incorporation of digital tools, designing value-based insurance models and reviewing policy decisions can help achieve improved adherence. Optimal adherence patterns and better health outcomes can be achieved with increased patient awareness, accessibility to information and collaboration between all stakeholders.
REFERENCES
  1. https://www.who.int/chp/knowledge/publications/adherence_introduction.pdf.
  2. Mills EJ et al. PLoS Medicine. 2006; 3(11):e438.
  3. Brown MT and Bussell JK. Mayo clinic proceedings. 2011 Apr; 86(4):304–314.
  4. Iuga AO and McGuire MJ. Risk Manag. Healthc. Policy. 2014 Feb; 7:35–44.
  5. https://www.nehi.net/writable/publication_files/file/pa_issue_brief_final.pdf.
  6. https://www.capgemini.com/wp-content/uploads/2017/07/Estimated_Annual_Pharmaceutical_Revenue_Loss_Due_to_Medication_Non-Adherence.pdf.
  7. Benjamin RM. Public Health Rep. 2012 Jan-Feb; 127(1): 2–3.
  8. Scalpel S. Mo Med. 2018 Jan-Feb; 115(1): 11.