Does non-adherence to DMARDs influence hospital-related healthcare costs for early arthritis in the first year of treatment?

Abstract

IntroductionNon-adherence to disease-modifying antirheumatic drugs (DMARDs) is suspected to relate to health care costs. In this study we investigated this relation in the first year of treatment.MethodsIn a multi-center cohort study with a one year follow up, non-adherence was continuously measured using electronic monitored medication jars. Non-adherence was defined as the number of days with a negative difference between expected and observed opening of the container. Cost measurement focused on hospital costs in the first year: consultations, emergency room visits, hospitalization, medical procedures, imaging modalities, medication costs, and laboratory tests. Cost volumes were registered from patient medical files. We applied multivariate regression analyses for the association between non-adherence and costs, and other variables (age, sex, center, baseline disease activity, diagnosis, socioeconomic status, anxiety and depression) and costs.ResultsOf the 275 invited patients, 206 were willing to participate. 74.2% had rheumatoid arthritis, 20.9% had psoriatic arthritis and 4.9% undifferentiated arthritis. 23.7% of the patients were more than 20% non-adherent over the follow-up period. Mean costs are € 2117.25 (SD € 3020.32). Non-adherence was positively related to costs in addition to baseline anxiety.ConclusionNon-adherence is associated with health care costs in the first year of treatment for arthritis. This suggests that improving adherence is not only associated with better outcome, but also with savings.

Medication adherence has an impact on disease activity in rheumatoid arthritis: a systematic review and meta-analysis

“… 9 The consequences of nonadherence will not only affect the patient’s disease activity, but also the rheumatologist’s treatment decisions, and lead to higher health care costs. 10 At the individual level, large differences in treatment response, as often measured with the 28-joint count disease activity score (DAS-28), which consists of 28 swollen and tender joint counts (SJC and TJC), patient’s assessment of disease activity (visual analog scale [VAS]) and erythrocyte sedimentation rate (ESR), are observed. 6 Instead of ESR, C-reactive protein (CRP) as another important indicator was also used to measure disease activity in RA patients.…”

Prevalence and Associated Factors for Non-adherence in Patients with Rheumatoid Arthritis

“…Among the questionnaires, we selected more objective questions that asked the number of days the patient failed to take their medication, and defined non-adherence failure to take medication 6 days or more. Compared to previous studies, the adherence rate of 90.4% is quite high [9][10][11][12][13][14][15][16][17][18][20][21][22][23][24][25][26][27][28][29]. We assumed that this result was due to the characteristics of the patient cohort rather than our method of estimation.…”

Recommendations for the assessment and optimization of adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: A process based on literature reviews and expert consensus

“…In several chronic diseases, the management of patients not adhering to their treatment is associated with higher health costs compared to that of adherent patients (10). In RA, poor patient adherence can compromise treatment effectiveness, decrease quality of life and appears to increase health care costs by around 33% (24,25).…”

“…In all, 22 studies were analysed: most(18) were performed on RA patients. The results were mitigated since of 13 randomized controlled trials (1535 patients), only 5 were positive (774 patients)(10,24,25).…”