One in Eight ASCVD Patients Report Medication Nonadherence Due to Costs

A new analysis published in Circulation reveals that many patients with atherosclerotic cardiovascular disease (ASCVD) reported nonadherence due to costs.

“Medication nonadherence is associated with worse outcomes in patients with ASCVD, a group who requires long-term therapy for secondary prevention,” the researchers explained in their study. “It is important to understand to what extent drug costs, which are potentially actionable factors, contribute to medication nonadherence.”

The study cohort consisted of a nationally representative survey of US adults who participated in the National Health Interview Survey between 2013 and 2017 (n=14,279). Participants were aged 18 years or older and had a reported history of ASCVD. The researchers determined a participant to have experienced cost-related nonadherence (CRN) if the reported skipping medication doses to save money within the previous 12 months, taking less medication to save money, or delaying filling prescriptions to save money. The authors then employed a survey analysis to obtain national estimates.

According to the analysis results, a weighted 12.6% (or 2.2 million; 95% CI, 2.1 to 2.4) of the surveyed participants experienced CRN, including 8.6% missing doses (1.5 million), 8.8% taking lower-than-prescribed doses (1.6 million), and 10.5% intentionally delaying filling prescriptions to save money (1.9 million). A number of factors were associated with CRN, including age over 65 years, female sex, low family income, lack of health insurance, and high comorbidity burden. The authors reported that respondents reporting CRN had a 10.8-fold higher odds of requesting low-cost medications and 8.9-fold higher odds of using alternative, nonprescription therapies compared to those who had not reported CRN.

“One in eight patients with ASCVD reports nonadherence to medications because of cost, the researchers wrote. “The removal of financial barriers to accessing medications, particularly among vulnerable patient groups, may help improve adherence to essential therapy to reduce ASCVD morbidity and mortality.”

Medication non-adherence due to cost 2013-2017!

AT RISK:

These are people with heart & vascular disease who opt to delay taking, or cut the dose, or skip a dose of their prescribed medications to save moneyhttps://t.co/mXtWAdFc9A@AmerMedicalAssn @CDCDirector @ACEPNow

— Elias Said, MD, FACEP (@MdFacep) November 26, 2019

Very troubling.
Congrats @rohan_khera @sandeepdasmd @khurramn1! Also, love that this has hit the front page of @reddit! https://t.co/waiS0dCs9j

— Nimish Shah, MD (@NNShahMD) November 26, 2019

Creating the evidence for govt. single payer from the usual suspects. It goes unmentioned that aspirin/statins/anti-hypertensives are available for $4/month. Non-adherence in patients who say they skip because of cost is either poor guidance from docs, or the issues r deeper https://t.co/bmVYGGGLIl

— Anish Koka, MD (@anish_koka) November 25, 2019

This is vastly worrying. There has been a decreasing trend in uninsurance, but #underinsurance has been steadily growing. We solved a problem, only to feed/create an equally big one. Amazing to team up with @rohan_khera once more!! https://t.co/i3YKp9ZUa8

— Javier Valero (@jvaleromd) November 25, 2019

The consequences of unaffordable drug prices in the US published in this week’s @CircAHA protecting #OurNHS from free trade deal negotiations should be a national priority #GE2019 @drphilhammond @mgtmccartney https://t.co/bfm0b9ifpg

— Nicholas Mills (@HighSTEACS) November 27, 2019