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Medication adherence issues in patients: focus on cost  [cached]
Matsui D
Clinical Audit , 2013,
Abstract: Doreen Matsui Department of Pediatrics and Medicine, University of Western Ontario, London, Ontario, Canada; Children's Hospital, London Health Sciences Centre, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada Abstract: Advances in drug therapy have resulted in efficacious treatments being available; however, the benefit may be lost if prescribed medications are not taken properly. Unfortunately, poor medication adherence is common and widespread, affecting all age groups and disease conditions. Adherence is a factor in health outcomes of pharmacotherapy with possible failure to achieve therapeutic goals and worsening of illness. Higher health care costs may result from more frequent physician and emergency department visits and increased hospitalization rates. The cost of medications may play a role in whether patients do or do not take their medication with increased cost sharing leading to poorer adherence with prescription drugs. Given the possible adverse consequences of nonadherence, interventions to improve medication-taking behavior are encouraged although not consistently successful. Surprisingly, there is relatively little information on the cost-effectiveness of these interventions and more methodologically sound research is needed in this area. Alternative strategies that have been proposed are value-based insurance design and the use of financial incentives, although the former has not been widely accepted, and the latter is ethically controversial. This article reviews some of the main issues with regards to adherence with drug therapy including some of the cost implications of less than optimal medication adherence. Keywords: adherence, medication, cost
Medication adherence issues in patients: focus on cost
Matsui D
Clinical Audit , 2013, DOI: http://dx.doi.org/10.2147/CA.S30125
Abstract: ication adherence issues in patients: focus on cost Review (490) Total Article Views Authors: Matsui D Published Date March 2013 Volume 2013:5 Pages 33 - 42 DOI: http://dx.doi.org/10.2147/CA.S30125 Received: 09 November 2012 Accepted: 11 January 2013 Published: 11 March 2013 Doreen Matsui Department of Pediatrics and Medicine, University of Western Ontario, London, Ontario, Canada; Children's Hospital, London Health Sciences Centre, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada Abstract: Advances in drug therapy have resulted in efficacious treatments being available; however, the benefit may be lost if prescribed medications are not taken properly. Unfortunately, poor medication adherence is common and widespread, affecting all age groups and disease conditions. Adherence is a factor in health outcomes of pharmacotherapy with possible failure to achieve therapeutic goals and worsening of illness. Higher health care costs may result from more frequent physician and emergency department visits and increased hospitalization rates. The cost of medications may play a role in whether patients do or do not take their medication with increased cost sharing leading to poorer adherence with prescription drugs. Given the possible adverse consequences of nonadherence, interventions to improve medication-taking behavior are encouraged although not consistently successful. Surprisingly, there is relatively little information on the cost-effectiveness of these interventions and more methodologically sound research is needed in this area. Alternative strategies that have been proposed are value-based insurance design and the use of financial incentives, although the former has not been widely accepted, and the latter is ethically controversial. This article reviews some of the main issues with regards to adherence with drug therapy including some of the cost implications of less than optimal medication adherence.
The Impact of Comorbid Depression on Adherence to Therapy for Multiple Sclerosis  [PDF]
M. Tarrants,M. Oleen-Burkey,J. Castelli-Haley,M. J. Lage
Multiple Sclerosis International , 2011, DOI: 10.1155/2011/271321
Abstract: Objective. Examine the impact of comorbid depression on adherence to disease-modifying therapy (DMT) for multiple sclerosis (MS). Methods. A retrospective database was used to identify patients with MS treated with a DMT. Patients with MS and comorbid depression were matched to patients with MS only. Adherence to DMT was proxied by the medication possession ratio (MPR) and multivariate regressions were used to examine the association between comorbid depression and adherence to DMT. Results. Patients with comorbid depression had a 10 point lower MPR ( ) and were less likely to achieve a MPR of at least 80% (odds ratio ; 95% confidence interval (CI) 0.42–0.74) than those without depression. While treatment with an antidepressant generally had no significant impact on the likelihood of achieving an MPR threshold of 80% ( ; 95% CI 0.50–3.48), adherence to antidepressant therapy guidelines were associated with improved adherence to DMT therapy. Conclusions. MS patients with comorbid depression were approximately half as likely to be adherent to their DMT relative to patients with MS without depression. Although treatment with antidepressant therapy generally did not improve the likelihood of adherence, treatment with antidepressants for at least 6 months was associated with better adherence to DMT. 1. Introduction Multiple sclerosis (MS) is the most common disabling neurological condition for young adults and adolescents in the United States [1]. Approximately 400,000 Americans have MS, and every week about 200 people are diagnosed with the disease [2]. While the results of the existing burden-of-illness studies conducted for MS in the United States vary according to the data sources used [3], they all report substantial economic impacts of MS, both to the individual and to the nation. The cost of each MS relapse has been reported to be approximately $12,870 [4]. The average cost of MS for the individual patient, each year, is anywhere from $12,879 (2004 USD) [5] to $34,000 (1994 USD) [6]. These figures translate to a national cost of $5.2 billion ($12,879 × 400,000 Americans diagnosed with MS) [5] to $6.8 billion (based on prevalence figures used by the authors of [6], annually. While MS is incurable, Food and Drug Administration- (FDA-) approved disease-modifying therapies (DMTs) have been shown to reduce the rate of relapse and to slow disease progression [7, 8]. However, medication can only work if it is taken. Lack of medication adherence has been shown to be associated with increased patient morbidity, poorer quality of life, and increased financial
Antihypertensive therapy among newly treated patients: An analysis of adherence and cost of treatment over years
Luca Degli Esposti, Stefania Saragoni, Paolo Batacchi, et al
ClinicoEconomics and Outcomes Research , 2010, DOI: http://dx.doi.org/10.2147/CEOR.S11933
Abstract: ntihypertensive therapy among newly treated patients: An analysis of adherence and cost of treatment over years Review (3530) Total Article Views Authors: Luca Degli Esposti, Stefania Saragoni, Paolo Batacchi, et al Published Date July 2010 Volume 2010:2 Pages 113 - 120 DOI: http://dx.doi.org/10.2147/CEOR.S11933 Luca Degli Esposti1, Stefania Saragoni1, Paolo Batacchi2, Pierangelo Geppetti3, Stefano Buda1, Ezio Degli Esposti4 1CliCon S.r.l., Health, Economics and Outcomes Research, Ravenna; 2Pharmaceutical Policy Department, Local Health Unit of Florence; 3Department of Preclinical and Clinical Pharmacology, University of Florence; 4Outcomes Research Unit, Policlinics Umberto I, Rome, Italy. Objective: To perform a time-trend analysis of adherence and cost of antihypertensive -treatment over four years. Methods: A population-based retrospective cohort study was conducted. We included subjects ≥18 years, and newly treated for hypertension with diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers between 01 January 2004 and 31 December 2007. One-year adherence to antihypertensive therapy was calculated and classified as low, low-intermediate, intermediate, high-intermediate, and high. The direct cost of antihypertensive medications was evaluated. Results: We included data for a total of 105,512 patients. The number of newly treated subjects decreased from 27,334 in 2004 to 23,812 in 2007, as well as antihypertensive drug therapy cost which decreased from €2,654,166 in 2004 to €2,343,221 in 2007. On the other hand, in the same time frame, the percentage of adherent newly treated subjects increased from 22.9% to 28.0%. Compared with subjects initiated on angiotensin receptor blockers (odds ratio [OR] = 1), the risk of nonadherence was higher in those initiated on angiotensin-converting enzyme inhibitors (OR = 1.19), combination therapy (OR = 1.44), beta-blockers (OR = 1.56), calcium channel blockers (OR = 1.67), and diuretics (OR = 4.28). Conclusions: The findings of the present study indicate that suboptimal adherence to antihypertensive medication occurs in a substantial proportion of treated patients, and improvements in treatment adherence were obtained but are still unsatisfactory.
Antihypertensive therapy among newly treated patients: An analysis of adherence and cost of treatment over years  [cached]
Luca Degli Esposti,Stefania Saragoni,Paolo Batacchi,et al
ClinicoEconomics and Outcomes Research , 2010,
Abstract: Luca Degli Esposti1, Stefania Saragoni1, Paolo Batacchi2, Pierangelo Geppetti3, Stefano Buda1, Ezio Degli Esposti41CliCon S.r.l., Health, Economics and Outcomes Research, Ravenna; 2Pharmaceutical Policy Department, Local Health Unit of Florence; 3Department of Preclinical and Clinical Pharmacology, University of Florence; 4Outcomes Research Unit, Policlinics Umberto I, Rome, Italy.Objective: To perform a time-trend analysis of adherence and cost of antihypertensive -treatment over four years.Methods: A population-based retrospective cohort study was conducted. We included subjects ≥18 years, and newly treated for hypertension with diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers between 01 January 2004 and 31 December 2007. One-year adherence to antihypertensive therapy was calculated and classified as low, low-intermediate, intermediate, high-intermediate, and high. The direct cost of antihypertensive medications was evaluated.Results: We included data for a total of 105,512 patients. The number of newly treated subjects decreased from 27,334 in 2004 to 23,812 in 2007, as well as antihypertensive drug therapy cost which decreased from €2,654,166 in 2004 to €2,343,221 in 2007. On the other hand, in the same time frame, the percentage of adherent newly treated subjects increased from 22.9% to 28.0%. Compared with subjects initiated on angiotensin receptor blockers (odds ratio [OR] = 1), the risk of nonadherence was higher in those initiated on angiotensin-converting enzyme inhibitors (OR = 1.19), combination therapy (OR = 1.44), beta-blockers (OR = 1.56), calcium channel blockers (OR = 1.67), and diuretics (OR = 4.28).Conclusions: The findings of the present study indicate that suboptimal adherence to antihypertensive medication occurs in a substantial proportion of treated patients, and improvements in treatment adherence were obtained but are still unsatisfactory.Keywords: antihypertensive therapy, adherence, cost, administrative databases.
Liraglutide vs Exenatide: Patient Adherence, Medication Persistence and Economic Evaluation in the Treatment of Type 2 Diabetes Mellitus  [PDF]
Fiorenzo Santoleri, Paola Sorice, Ruggero Lasala, Alberto Costantini
Pharmacology & Pharmacy (PP) , 2014, DOI: 10.4236/pp.2014.54040
Abstract:

Introduction: Liraglutide and Exenatide are used in adults who are affected by type-2 diabetes to control their blood glucose level. They are administered by the patients by subcutaneous injection, Liraglutide once a day while Exenatide twice a day. The aim of this study was to evaluate medication adherence and persistence of treatment with Liraglutide and Exenatide with a new strategy of calculation also giving economic evaluations on therapy costs for Received Daily Dose. Materials and Methods: In this retrospective study, we took into account 16 months from 1st September 2011 to 31st December 2012. Treatment adherence was quantified utilizing the ratio between RDD and Prescribed Daily Dose (PDD). Persistence is calculated into account the actual therapy days, comparing posology with supplied dose and the graph is drawn using Kaplan-Meir method. Results: The number of patients studied for Liraglutide was 114 and 220 and 58 and 60 for Exenatide respectively in 2011 and 2012. Adherence to therapy, calculated as the ratio between RDD and PDD, in 2011 was 0.93 for Exenatide and 0.87 for Liraglutide, while in 2012 it was 0.94 and 0.90 for Liraglutide and Exenatide, respectively. The cost per day of therapy (cost per RDD) for Liraglutide was €2.88 and €2.78 and for Exenatide was €2.37 and €2.48 in 2011 and 2012, respectively. Conclusion: The dosage regimen, therefore, plays an important role in improving the medication adherence.

Evaluation of a pharmacist-managed diabetes medication therapy adherence clinic
Lim,Phei Ching; Lim,Kelvin;
Pharmacy Practice (Internet) , 2010, DOI: 10.4321/S1886-36552010000400008
Abstract: patient adherence to prescribed medication regimens is important in diabetes care to prevent or delay microvascular and macrovascular complications such as retinopathy, nephropathy and myocardial infarction. in penang hospital, malaysia, pharmacists collaborate with physicians in diabetes care through a pharmacist-managed diabetes medication therapy adherence clinic (dmtac) in the endocrine clinic, in operation since 2006. objective: to evaluate the effectiveness of the pharmacist-managed dmtac program in improving glycaemic control, lipid parameters and patients′ medication adherence. method: a retrospective study among patients enrolled in the dmtac program was conducted between september 2007 and december 2008. data was included from patients with a glycosylated haemoglobin (hba1c) >8% and who had completed eight visits with the pharmacists. medical records and dmtac forms that provided patients′ demographics, medication regimens, adherence and laboratory parameters as well as pharmacists′ interventions were reviewed. hba1c, fasting blood glucose (fbg), low-density lipoprotein cholesterol (ldl), triglycerides (tg) and high-density lipoprotein cholesterol (hdl) were evaluated. documented data of patients′ adherence to medication regimen [modified morisky medication adherence score (mmmas); high adherence if score >8, medium adherence if score 6 to <8 and low adherence if score <6] was also evaluated. results: a total of 43 patients (53.5% females; 46.5% malays, 44.2% chinese and 9.3% indians) were included in the analysis. a mean reduction in hba1c of 1.73% (p<0.001), mean reduction in fbg of 2.65mmol/l (p=0.01) and mean reduction in ldl cholesterol of 0.38mmol/l (p=0.007) were achieved. the difference in tg and hdl cholesterol were not significant. patients′ adherence to medication regimens improved significantly with an increase in the mean mmmas score from 7.00 to 10.84 (p<0.001) after completion of the dmtac program. conclusion: the pharmacist-managed dmtac pr
Beliefs that influence cost-related medication non-adherence among the “haves” and “have nots” with chronic diseases
Piette JD, Beard A, Rosland AM, McHorney CA
Patient Preference and Adherence , 2011, DOI: http://dx.doi.org/10.2147/PPA.S23111
Abstract: eliefs that influence cost-related medication non-adherence among the “haves” and “have nots” with chronic diseases Original Research (4530) Total Article Views Authors: Piette JD, Beard A, Rosland AM, McHorney CA Published Date August 2011 Volume 2011:5 Pages 389 - 396 DOI: http://dx.doi.org/10.2147/PPA.S23111 John D Piette1, Ashley Beard1, Ann Marie Rosland1, Colleen A McHorney2 1Ann Arbor VA Healthcare System, Ann Arbor, MI, USA and the University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, MI, USA; 2US Outcomes Research, Merck and Co, Inc, North Wales, PA, USA Background and objective: Some patients continue taking their medication as prescribed despite serious financial pressures, while others with the ability to pay forego treatment due to cost concerns. The primary goal of this study was to explore how patients' beliefs about the necessity of treatment and treatment side effects, influence cost-related non-adherence (CRN). Methods: 27,302 participants in the Harris Interactive Chronic Illness Panel completed an internet survey. The current study focused on two subsamples representing: (a) the most economically-vulnerable survey respondents (ie, individuals with household incomes of US$25,000 per year or less and monthly out-of-pocket medication costs of at least US$60, n = 1321); and (b) respondents who were the most likely to have the financial resources to pay for medications (ie, those with incomes of US$125,000 or more and monthly medication costs of less than US$60.00, n = 1195). Multivariate models were constructed for each group to determine the independent impact on CRN of perceived need for medications and side-effect concerns. Increased risk for CRN associated with depression and asthma diagnoses also was examined. Results: Twenty-one percent of economically vulnerable respondents reported continuing to take their medication as prescribed despite serious cost pressures, while 14% of high-income respondents reported CRN despite apparently manageable out-of-pocket costs. Both low perceived need for medications and concerns about side-effects affected CRN risk in low-income and high-income groups. Within groups of both low-income and high-income respondents, depression and asthma significantly increased patients' odds of reporting CRN. Conclusion: Beyond objective financial measures, CRN is influenced by patient beliefs, which can influence the perceived value of prescription drugs. Addressing these beliefs, as well as the unique adherence concerns of patients with depression and asthma, could decrease CRN rates even if cost pressures themselves cannot be reduced.
Evaluation of a pharmacist-managed diabetes medication therapy adherence clinic  [cached]
Lim PC,Lim K
Pharmacy Practice (Granada) , 2010,
Abstract: Patient adherence to prescribed medication regimens is important in diabetes care to prevent or delay microvascular and macrovascular complications such as retinopathy, nephropathy and myocardial infarction. In Penang Hospital, Malaysia, pharmacists collaborate with physicians in diabetes care through a pharmacist-managed Diabetes Medication Therapy Adherence Clinic (DMTAC) in the Endocrine Clinic, in operation since 2006. Objective: To evaluate the effectiveness of the pharmacist-managed DMTAC program in improving glycaemic control, lipid parameters and patients’ medication adherence. Method: A retrospective study among patients enrolled in the DMTAC program was conducted between September 2007 and December 2008. Data was included from patients with a glycosylated haemoglobin (HbA1c) >8% and who had completed eight visits with the pharmacists. Medical records and DMTAC forms that provided patients’ demographics, medication regimens, adherence and laboratory parameters as well as pharmacists’ interventions were reviewed. HbA1c, fasting blood glucose (FBG), low-density lipoprotein cholesterol (LDL), triglycerides (TG) and high-density lipoprotein cholesterol (HDL) were evaluated. Documented data of patients’ adherence to medication regimen [Modified Morisky Medication Adherence Score (MMMAS); high adherence if score >8, medium adherence if score 6 to <8 and low adherence if score <6] was also evaluated. Results: A total of 43 patients (53.5% females; 46.5% Malays, 44.2% Chinese and 9.3% Indians) were included in the analysis. A mean reduction in HbA1c of 1.73% (p<0.001), mean reduction in FBG of 2.65mmol/l (p=0.01) and mean reduction in LDL cholesterol of 0.38mmol/l (p=0.007) were achieved. The difference in TG and HDL cholesterol were not significant. Patients’ adherence to medication regimens improved significantly with an increase in the mean MMMAS score from 7.00 to 10.84 (p<0.001) after completion of the DMTAC program. Conclusion: The pharmacist-managed DMTAC program resulted in significant improvements in HbA1c, glucose and LDL cholesterol levels as well as medication adherence in patients with diabetes.
An economic evaluation of anticipated costs and savings of a behavior change intervention to enhance medication adherence
Wiegand,Phillip N.; Wertheimer,Albert I.;
Pharmacy Practice (Internet) , 2008, DOI: 10.4321/S1886-36552008000200002
Abstract: medication adherence across disease states is generally poor. research has focused on various methods to improve medication adherence, but there is little conclusive evidence regarding specific methods efficacy. the transtheoretical model for behavior change has been used to modify existing addictive behaviors but not in medication adherence specifically. as a behavioral component is inherently related to medication adherence, it is thought that this model may be applicable. objective: the purpose of this research is to evaluate the costs and savings of implementing a novel behavioral intervention against the cost of poor medication adherence to determine whether further development is realistic. methods: the basic tools required to administer this intervention were determined through primary literature review and priced by vendors supplying such materials. diabetes mellitus type 2 (dm2) was used as a vehicle to establish the cost of care for long-term complications of a chronic disease. the primary literature provided information regarding the cost of care for dm2 morbidity and outpatient annual drug therapy expenditure. the total cost of the behavioral intervention components and the cost of care for dm2 morbidity were applied to a theoretical cohort of 1000 patients. by dividing this cost across 1000 patients, a per-patient cost was yielded and multiplied over a 16-year timeframe. results: it was found that the cost to implement the behavioral intervention and resultant medication costs is usd13,574 per-patient over 16 years. the cost to treat complications of diabetes mellitus is usd 36,528 per patient over the 16 years. the total amount of healthcare dollars potentially saved by utilizing this intervention is usd 22,954 per-patient. conclusions: it appears that the cost to implement this behavioral intervention is reasonable and permits further evaluation in other chronic conditions with notoriously poor adherence levels.
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