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What Does Patient Non-Adherence to Medication Really Cost?

For years, those of us in healthcare have generally cited the following estimates to illustrate the impact that patient non-adherence has on cost and safety:

  • 20% - 30% of new prescriptions are never filled
  • 50% of medications are not taken as prescribed
  • Non-adherence costs the U.S. healthcare system $100B-$300B per year
  • 125,000 people die annually from not taking their medicines

Most of this data comes from a literature review published in the Annals of Internal Medicine in 2012. The reviewers didn’t actually conduct primary research or analysis on the cost of non-adherence. They evaluated existing papers, studies, and other reviews that addressed the issue.

Although the review was published in 2012, most of the studies included in it were published in the early 2000s, with some being as recent as 2009. Nonetheless, it was a solid review and the best resource available to estimate the costs and mortality associated with non-adherence.

Enter a new paper published this year in the The Annals of Pharmacotherapy. Its authors analyzed the total costs of what they refer to as “non-optimized prescription drug use and average pathway costs for a patient who experienced a treatment failure (TF), a new medical problem (NMP), or a TF and NMP.”[1] The authors’ goal was to estimate the cost of prescription drug-related morbidity and mortality in the U.S., with non-adherence being one of multiple reasons for what they term “non-optimized medication regimens.”

Estimates from this latest study are:

  • The annual cost of prescription drug-related morbidity and mortality resulting from non-optimized medication therapy is $528.4B in 2016 US dollars, with a plausible range of $495.3 billion to $672.7 billion
  • Non-optimized drug therapy results in about 275,689 deaths per year

It’s pretty striking data. And it goes beyond just patient non-adherence, which is really a more accurate way to look at the situation. In essence, this new research provides a more complete view of the real costs of medication-related treatment failures and new medical problems associated with non-optimized medication use. Again, non-adherence is just one of them. As one pharmacist who commented on the new study said about the way our health system has perceived past cost data:

“The fact is that many people [assumed] that the $300 billion is the result of non-adherence when it would be better to say that the cost is related to the entire range of inappropriate medication use in the United States.”[2]

Non-optimization that results in treatment failures could include, for instance, the cost of readmissions or additional doctor visits. Non-optimization that results in new medical problems could include, for instance, adverse drug events or side effects. All of these outcomes potentially result from patient non-adherence. But there are other factors at play too. 

One example is the spiraling costs of medications themselves combined with the context of suboptimal use of the medications and the patient's adherence. If a patient is placed on Harvoni for Hepatitis C treatment, the average cost of a typical 12 week course of therapy (for non cirrhotic patients) is $90,000 and the medication is 99% effective in eradicating the disease. But if the patient becomes non-adherent and stops taking the medication after the first 30 or 60 days, the patient will not be cured and will have wasted $30,000 or $60,000.

The way this new study tallies the numbers integrates outcomes such as these and is therefore a more accurate way to consider the real costs that result from prescribed medications being taken or managed sub-optimally.

The takeaway for healthcare leaders is that medication non-adherence by patients is only one of many cost and death drivers. It’s certainly big. But the entire cost of suboptimal medication regimens is huge. The organizers of the newer study conclude that expanding medication management programs overseen by clinical pharmacists and collaborating with physicians and other prescribers can mitigate these avoidable costs and improve patient outcomes.

[1] Cost of Prescription Drug-Related Morbidity and Mortality. Watanabe JH, McInnis T, Hirsch JD. Annals of Pharmacotherapy, 2018. https://www.ncbi.nlm.nih.gov/pubmed/29577766 

[2] Does Non-adherence Really Cost the Health Care System $300 Billion Annually? Timothy Aungst, PharmD, Pharmacy Times, JUNE 01, 2018. https://www.pharmacytimes.com/contributor/timothy-aungst-pharmd/2018/06/does-nonadherence-really-cost-the-health-care-system-300-billion-annually

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