The impact of non-adherence on cardiovascular disease treatments: higher costs and worse outcomes

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Cardiovascular

Cardiovascular

The impact of non-adherence on cardiovascular disease treatments: higher costs and worse outcomes

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Key Messages 

  • Medication non-adherence is pervasive and costly; available cost estimates for developed countries total $290 billion in the U.S. and €1.25 billion in Europe each year
  • Poor adherence to cardiovascular disease treatments is a driver of worse outcomes, including increased risk of mortality, hospitalization, and recurrent events

 

Pharmacological treatments represent a significant opportunity area.

Medication adherence is a key determinant of the effectiveness of pharmacological therapies, including for patients with cardiovascular disease and other chronic conditions.1 Cardiovascular diseases are a global problem, and more than 80% of cardiovascular disease deaths occur in low- and middle-income countries.2 Pharmacological treatments can dramatically improve cardiovascular outcomes, including reduced risk of costly acute events such as myocardial infarction, stroke and hospitalization.1 Nevertheless, non-adherence to cardiovascular disease treatments is pervasive.3

Treatment non-adherence is a global issue driving negative outcomes and increased costs.

The magnitude of costs associated with non-adherence is staggering: non-adherence is responsible for $290 billion in annual healthcare costs in the U.S. and at least €1.25 billion in Europe.4 In the UK, non-adherence costs the NHS more than £500 million per year.5 Studies in the U.S. indicate that medication non-adherence is the cause of 10% of hospitalizations and 23% of nursing home admissions among older adults, with the typical patient who is nonadherent requiring three extra medical visits per year and an additional $2,000 in treatment costs per annum.4,6 Given that secondary prevention medicines are often difficult to access and afford in many developing countries, non-adherence rates and their associated consequences in terms of healthcare costs are almost certainly worse.2

Improving adherence to cardiovascular disease treatments would reduce disease costs.

Adherence to cardiovascular disease treatments is estimated to be comparable to the global rate of 50% for chronic therapies.7,9 Poor adherence to cardiovascular disease treatments is a major cause of worse outcomes, including increased risk of mortality, hospitalization or recurrent cardiovascular events.7 According to one estimate, 125,000 avoidable deaths occur each year in the U.S. due to poor adherence to cardiovascular disease treatment.6 Regarding costs, one study showed that patients who were nonadherent to statins  had total healthcare costs as high as $900* more and an increased likelihood of a related hospitalization compared to patients who adhered to recommendations.8 Likewise, adherence to statins has been shown to lower total healthcare costs, with increased medication costs offset by lower costs for ambulatory care and hospitalization.9 According to one estimate, improving patient adherence to statins in the U.S. could save the healthcare system more than $3 billion each year.8

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Addressing cardiovascular disease indirect costs is a significant opportunity area.

One study in the U.S. calculated a 61% increase in business costs associated with lost productivity due to cardiovascular disease, with costs expected to increase from $172 billion in 2010 to $276 billion in 2030.10 The non-medical cost burden associated with cardiovascular disease is expected to be particularly high in developing countries, where working class populations are more likely to be affected. For example, in Sub-Saharan Africa, half of cardiovascular deaths occur in the working-aged group of 30–69, at least ten years earlier than in developed countries.2 In Russia, cardiovascular disease is the leading cause of death for men aged 45 and older.11 Of course, the loss of a family bread-winner can be economically devastating for the family and has implications for the whole society.  Simple behavioral interventions that can address cardiovascular medication non-adherence, alleviate symptoms, and avoid complications therefore have significant potential to reduce these financial and non-financial ripple effects from the growing epidemic of cardiovascular disease.

 

Improving cardiovascular disease trends requires a comprehensive understanding of adherence drivers.

The magnitude of the cardiovascular disease epidemic coupled with the negative impact of non-adherence demands a solution. Factors influencing adherence are multiple and complex. Initiatives to improve adherence must be rooted in a comprehensive understanding of the drivers of adherence problems and how they might be addressed. Physicians have a key role to play in improving cardiovascular patients’ adherence – both to medications and to lifestyle recommendations. In future articles we will examine in detail exactly what those behavioral drivers are and provide simple tools and strategies to healthcare professionals to help them “nudge” patient behavior towards adherence. Just as physicians must make the proper clinical diagnosis and treatment decision, they can have a considerable impact on outcomes by making the right behavioral diagnosis and treatment choices. This will be the objective of future articles.

References
1. Brown, Marie T, and Jennifer K Bussell. “Medication adherence: WHO cares?.” Mayo Clinic proceedings vol. 86,4 (2011): 304-14. doi:10.4065/mcp.2010.0575 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/
2. Gheorghe, Adrian et al. “The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review.” BMC public health vol. 18,1 975. 6 Aug. 2018, doi:10.1186/s12889-018-5806-x
3. Kisa, Adnan & Sabaté, Eduardo & Nuño-Solinís, Roberto. (2003). ADHERENCE TO LONG-TERM THERAPIES: Evidence for action. Eur J Cardiovasc Nurs. 2003 Dec;2(4):323. https://apps.who.int/medicinedocs/pdf/s4883e/s4883e.pdf
4. Cutler, Rachelle Louise et al. “Economic impact of medication non-adherence by disease groups: a systematic review.” BMJ open vol. 8,1 e016982. 21 Jan. 2018, doi:10.1136/bmjopen-2017-016982 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5780689/
5. Taylor, Lynne. “Drug Non-Adherence.” PharmaTimes, PharmaTimes Media Limited, 19 Feb. 2013, www.pharmatimes.com/news/drug_non-adherence_costing_nhs_500m_a_year_1004468.
6. Lynch, Shalini S. “Adherence to Drug Treatment - Drugs.” MSD Manual Consumer Version, MSD Manuals, Aug. 2019, www.msdmanuals.com/home/drugs/factors-affecting-response-to-drugs/adherence-to-drug-treatment.
7. Kronish, Ian M, and Siqin Ye. “Adherence to cardiovascular medications: lessons learned and future directions.” Progress in cardiovascular diseases vol. 55,6 (2013): 590-600. doi:10.1016/j.pcad.2013.02.001
8. Pittman, Donald, et al. Adherence to Statins, Subsequent Healthcare Costs, and Cardiovascular Hospitalizations. The American Journal of Cardiology vol. 107,11(2011): 1662-1666. doi:10.1016/j.amjcard.2011.01.052. www.ajconline.org/article/S0002-9149%2811%2900465-6/fulltext#secd15069848e1078.
9. Iuga, Aurel O, and Maura J McGuire. “Adherence and health care costs.” Risk management and healthcare policy vol. 7 35-44. 20 Feb. 2014, doi:10.2147/RMHP.S19801
10. Heidenreich, Paul A., et al. “Forecasting the Future of Cardiovascular Disease in the United States.” Circulation, American Heart Association, vol. 123,8(2011): 933–944. doi:10.1161/CIR.0b013e31820a55f5. www.ahajournals.org/doi/full/10.1161/CIR.0b013e31820a55f5?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&amp. 
11. Vyzhutovich, Valery. “Lawless Heart? Topic with Professor of the Russian Economic School Irina Denisova.” Russian Gazette, RGRU, Feb. 2019, rg.ru/2019/02/27/denisova-bolshe-50-smertej-v-rf-sviazany-s-zabolevaniiami-serdca-i-sosudov.html. 


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