Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact

Abstract

Background Cost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, are unclear. Objectives Our objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes. Methods We searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools. Results Twenty-six studies of varying quality (n = 483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1 to 10.2%. Factors predicting CRNA included high out-of-pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at 1 year. Conclusion CRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.

A systematic umbrella review of the association of prescription drug insurance and cost-sharing with drug use, health services use, and health

“…The review of cost-related nonadherence to prescription medications found limited and mixed evidence that cost-sharing increased health services use [ 46 ]. A more recent review examined the prevalence, predictors, and clinical impact of cost-related medication nonadherence in Canada [ 52 ]. Along with lower income, younger age, and poorer health, high out-of-pocket spending and drug insurance were found to be associated with medication cost-related nonadherence [ 52 ].…”

“…A more recent review examined the prevalence, predictors, and clinical impact of cost-related medication nonadherence in Canada [ 52 ]. Along with lower income, younger age, and poorer health, high out-of-pocket spending and drug insurance were found to be associated with medication cost-related nonadherence [ 52 ].…”

Development and validation of a social vulnerabilities survey for medical inpatients

“…Therefore, the relevance and representativeness of these social vulnerabilities remains unclear. While it is possible that the SVS does not capture other important social vulnerabilities in our patient population, the domains that are included likely remain relevant, with increasing evidence demonstrating their prevalence and/or their associations with hospital readmissions in heterogeneous, broad, populations 60–63. We also note that in our study, we asked specifically about social vulnerabilities that may be missing from the SVS—no patients felt that additional questions in additional domains were needed.…”

Risk Preferences, Rationality of Choices, and Willingness to Pay for Preventive Medicine in Patients with Graves’ Thyrotoxicosis

“…In consideration of other aspects of WTP for preventive medicine, it has been reported that spending for health care is closely related to household income worldwide. [27][28][29] In our previous study, we conducted exactly the same survey in patients with diabetes or stable endocrine or metabolic diseases. 16 By way of comparison, we performed multiple regression analysis of the factors associated with WTPcvr from the data of that study.…”