Medicine Is Most Expensive When It's Not Taken At All Jul 21st 2013, 10:00
(Photo credit: Tax Credits)
If you want to know the real value of medicines, some of the best evidence comes from studies of what happens when people don't take them. Recent research highlights the importance of adherence – the extent to which patients stick to their course of therapy – for realizing that value.
Conventional wisdom holds that pharmaceutical treatments are a major cause of high health care costs, but the fact is, medicines account for only about 10 percent of health care spending, and they're often the most cost-effective means of preventing and treating disease.
So making sure to take your medicine is good not just for individuals, but for the health care system as a whole.
An independent study released in June by the IMS Institute for Healthcare Informatics estimated that the U.S. health care system could save $213 billion annually if medicines were used properly.
The IMS study identified six factors in avoidable costs. The largest factor by far is nonadherence, accounting for nearly half of the potential savings – $105 billion, including $72 billion for hospital care. IMS studied the impact of nonadherence for six specific conditions – high cholesterol, diabetes, hypertension, osteoporosis, HIV, and congestive heart failure – and therefore underestimates avoidable costs for all diseases. But even this conservative estimate clearly shows that ensuring patients take their medicines can dramatically cut health care costs – not to mention the benefits to health and quality of life.
By comparison, total U.S. spending on pharmaceuticals in 2012 was $325 billion. If we can avoid costs equal to one third of that total simply by improving adherence for just six conditions, it's evident that medicines more than pay for themselves in the health care system.
An article in the July issue of Health Affairsechoes the IMS findings. A study of patients with diabetes, heart failure, and pulmonary disease who were enrolled in the Medicare Part D prescription drug program found that poor adherence was related to otherwise unnecessary medical and hospital services under Medicare Parts A and B costing from $49 to $840 per beneficiary per month.
Another study of adherence among patients with several chronic vascular conditions, published in Health Affairs in 2011, concluded "that despite higher pharmacy spending, medication adherence by patients with chronic vascular disease provides substantial medical savings, as a result of reductions in hospitalization and emergency department use."
Annual net savings per person amounted to nearly $8,000 for congestive heart failure and nearly $4,000 for hypertension and diabetes. The study found that increased pharmacy spending for adherence produced average benefit-cost ratios as high as 10:1 for these diseases.
The recent studies add to a growing body of research demonstrating that the effective use of medicines can reduce spending on other medical services, particularly in Medicare:
- The Congressional Budget Office has found that a 1 percent increase in the number of prescriptions filled would lead to a 0.20 percent decrease in overall medical spending among the Medicare population.
- And a 2011 study of Medicare Part D, published in the Journal of the American Medical Association, found that older Americans who previously lacked comprehensive drug coverage saved about $1,200 in medical costs the year they signed up for the program.
The good news from the IMS report is that we're making progress on adherence among patients with chronic conditions in the U.S. And the report highlights six innovative and effective programs – in the public, private, and non-profit sectors – to promote appropriate use of medicines.
IMS also points out that the growing availability of generic medicines has helped increase adherence. According to IMS, the rate of generic utilization in the U.S. – 84 percent – is higher than in any other country. But it's important to note that these generics are the legacy of huge investments to find and develop new innovative medicines in the first place. And the research on adherence points to the urgency of developing more new medicines to address needs that are not met by therapies currently available.
For example, Alzheimer's disease is expected to cost the United States more than $200 billion this year. Yet you don't find AD in the studies of potential savings from increased adherence … because there is as yet no medicine available to slow or stop the progression of this disease. But what if there were?
The adherence gap for diabetes also highlights the need for new medicines that are easier to take and better help patients manage their condition.
The stubborn problem of nonadherence makes it clear that medicines are not enough. Our health care system – including the companies that make medicines – must find new ways to help patients maintain their course of therapy. As part of those efforts, the pharmaceutical industry is committed to helping ensure that all U.S. citizens are able to access the medicines they need.
But the research on adherence also makes crystal clear the value of medicines in holding down health care costs for everyone – when they're properly used. It's further evidence that medicines – far from being the problem – are a big part of the solution.
YOUR COMMENT
