Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost

Sokol, Michael C.; McGuigan, Kimberly A.; Verbrugge, Robert R.; Epstein, Robert S.

doi:10.1097/01.mlr.0000163641.86870.af

Cited by 1,467 publications

(1,137 citation statements)

References 31 publications

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“…The degree to which patients adhere to medication also has larger societal ramifications. One large retrospective study found that high rates of medication adherence were associated with lower disease-related medical costs and significantly lower hospitalization rates for patients with diabetes, hypertension, hypercholesterolemia, and congestive heart failure [10]. Similar relationships were observed when adherence and health care costs were analyzed in patients with HIV [11] and osteoporosis [12].…”

Section: Introductionmentioning

confidence: 74%

Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia

et al. 2012

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Dramatically improved survival associated with tyrosine kinase inhibitor (TKI) therapy has transformed the disease model for chronic myeloid leukemia (CML) to one of long-term management, but treatment success is challenged with poor medication adherence. Many risk factors associated with poor adherence can be ameliorated by close monitoring, dose modification, and supportive care. Controlling risk factors for poor adherence in combination with patient education that includes direct communication between the health care team and the patient are essential components for maximizing the benefits of TKI therapy. Am. J. Hematol. 87:687-691, 2012. V V C 2012 Wiley Periodicals, Inc. IntroductionThe last three decades have witnessed extraordinary advances in the treatment of chronic diseases, among which tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia (CML) is perhaps one of the most outstanding examples. Between 1975 and 1977, the 5-year relative survival rate of patients with CML was only 24% [1]. Allogeneic stem cell transplantation offered a potential cure for a small subset of patients; however, the risk of serious infection, graft-versus-host disease, relapse, and mortality presented substantial limitations [2,3]. The introduction of imatinib (Gleevec 1 , Novartis Pharmaceuticals Corporation, East Hanover, NJ) in 2001 replaced interferon-a as the standard of care for CML patients, with a result of remarkable improvement in patient survival. For example, the 8-year follow-up analysis of imatinib treatment in 553 CML patients participating in the International Randomized Study of Interferon versus STI571 demonstrated an overall survival (OS) rate of 85%; OS was 93% when only CMLrelated deaths and those before stem cell transplantation are considered [4]. With this prolonged survival and the recent approval of the more potent agents nilotinib (Tasigna 1 , Novartis Pharmaceuticals Corporation, East Hanover, NJ) and dasatinib (Sprycel 1 , Bristol-Myers Squibb Company, Princeton, NJ), which may be able to provide additional survival benefit, CML more closely resembles a chronic rather than a fatal disease. A new challenge has arisen, however, stemming directly from the success of TKI therapy. Poor medication adherence has come into focus as a major impediment to successful treatment of patients with CML: New evidence has shown that inadequate adherence to imatinib and suboptimal outcomes are inextricably linked [5][6][7].Difficulty in maintaining high medication adherence is not limited to TKI therapy or patients with CML, however. Indeed, the problem is pervasive across chronic conditions. For example, a 2003 report from the World Health Organization found the average rate of long-term adherence for diseases such as asthma, diabetes, hypertension, and tuberculosis was only about 50% in developed countries, and assumed to be even lower in developing countries where health resources are fewer and access to care is unpredictable [8]. The report identified five key areas that affect adherence, includin...

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Section: Introductionmentioning

confidence: 74%

Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia

et al. 2012

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“…Despite the benefit of antihypertensive therapies, many studies suggested suboptimal adherence to these medications, particularly among older adults with multiple chronic conditions 4, 5, 6, 7, 8, 9, 10, 11. Nonadherence to antihypertensives is associated with increased risk for CVD, hospitalization, and healthcare costs 5, 12, 13, 14, 15, 16, 17. Many observational studies examined the relationship between antihypertensive adherence and CVD outcomes in the general hypertension population 5, 13, 17.…”

Section: Introductionmentioning

confidence: 99%

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Yang

Chang

Ritchey

et al. 2017

JAHA

102

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BackgroundAntihypertension medication (antihypertensive) adherence lowers risk of cardiovascular disease (CVD); few studies have examined this association among older adults.Methods and ResultsWe assessed this association among Medicare fee‐for‐service beneficiaries aged 66 to 79 years who were newly diagnosed with hypertension and initiated on antihypertensives in 2008–2009 (n=155 597). We calculated proportion of days covered (PDC) during follow‐up, using proportional subdistribution hazard models, to examine association between antihypertensive adherence and a composite CVD outcomes, including first incident of fatal/nonfatal acute myocardial infarction, ischemic heart disease, stroke/transient ischemic attack, and heart failure. During follow‐up (median 5.8 years and 798 621 person‐years), we documented 47 198 CVD events. Among beneficiaries, 60.8%, 30.3%, and 8.9% had PDC ≥80%, 40% to 79%, and <40%. Crude incidence of CVD events were 40.1 (95% CI, 40.0–40.1), 93.9 (93.8–93.9), and 98.1 (98.1–98.2) per 1000 person‐years for PDC ≥80%, 40% to 79%, and <40%, respectively. Adjusted hazard ratios for CVD events were 1.0 (<40% as reference), 1.0 (0.97–1.03) for 40% to 79%, and 0.44 (0.42–0.45) for ≥80% (P<0.001). Dose‐response analysis suggested a nonlinear relationship between PDC and risk for CVD events with a protective effect of ≥80%. The pattern of associations between PDC and ischemic heart disease, stroke/transient ischemic attack, and heart failure were largely consistent as for CVD events and across different groups.ConclusionsAntihypertensive adherence was associated with a significantly lower risk of CVD events among older adults. There appeared to be a threshold effect in reducing CVD events at around PDC 80%, above which the risk for CVD reduced substantially.

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“…Although effective pharmaceutical treatments are readily available and reduce the risk for major cardiovascular diseases,4 inadequate adherence among patients to hypertension medication and the inertia of physicians to intensify treatment contribute to substantial morbidity, mortality, hospitalization, and health care costs 5, 6, 7. Recent studies suggest that treatment intensification improves hypertension management even with suboptimal adherence and reduces risks of cardiovascular events and deaths 8, 9, 10, 11.…”

Section: Introductionmentioning

confidence: 99%

Treatment Intensification for Hypertension in US Ambulatory Medical Care

Lin

Mukamal

2016

JAHA

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BackgroundHypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care.Methods and ResultsUsing the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time.ConclusionsUS hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.

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Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost

Abstract: For some chronic conditions, increased drug utilization can provide a net economic return when it is driven by improved adherence with guidelines-based therapy.

Cited by 1,467 publications

References 31 publications

Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia

Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Treatment Intensification for Hypertension in US Ambulatory Medical Care

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