Drug Copayment and Adherence in Chronic Heart Failure: Effect on Cost and Outcomes

Abstract

Among patients with CHF, higher drug copayments were associated with poorer adherence. The change was relatively small and did not affect predicted total health care costs, but it was sufficient to increase the predicted risk of hospitalization for CHF.

The Pharmacist Role in Predicting and Improving Medication Adherence in Heart Failure Patients

“…6,23 Smaller cohort studies in U.S. patients had similar findings regarding race, where minority or nonwhite race were significant predictors for nonadherence. 8,21 Other interesting findings from large cohort studies with follow-up ranging from 1 to 5 years in the United States, 6,23,32 Canada, 29 and European countries 22,27 identified those with more severe HF, 27 a greater a reduction in quality of life. [8][9][10][11][12][13][14] Furthermore, the Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) study demonstrated that increased adherence to HF medications was associated with a 35% reduction in mortality (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.57-0.75, P < 0.0001).…”

“…6,8,10,12,[21][22][23][24][25][26][27][28][29][30][31][32] Table 1 may assist the health care provider in recognizing predictors that may impact adherence to HF medications. Table 2 depicts a summary of the studies identifying predictors of decreased 6,8,10,[21][22][23][24][25][26]28,29,32 and increased 8,12,22,[26][27][28]30,31 HF medication adherence. Large, observational cohort studies extracting adherence and demographic data from health insurance claims databases or HF registries with 2 to 4 years of follow-up data from the United States found some similar significant predictors for nonadherence, including male gender or nonwhite race.…”

“…The review also included studies that did not measure medication adherence, but which measured mortality or hospital admission/readmission outcomes. number of concomitant illnesses, 22 living alone, 22 no health insurance, 6 higher medication copays, 32 or hospitalization within 6 months of their initial HF admission 29 as significant predictors for nonadherence to HF medications. Two smaller observational studies that followed patients for 3 to 6 months found that twice daily dosing of medication increased the likelihood of nonadherence to HF medications.…”

“…Only 1 study, Cole et al (2006), evaluated the impact of medication copay on medication adherence in the HF population. 32 This study used prescription and medication claims data to estimate medication costs as predictors of adherence.…”

The Effect of Copayment on Medical Aid Beneficiaries in Korea

“…However, contradictory to the reduction of pharmacy visitation days, the total pharmacy costs increased, which shows similar results to the above. That is, medical expenditures for medical services increased, which did not impact the total amount of medical expenditures [18,19].…”