Factors Influencing Cost-Related Nonadherence to Medication in Older Adults: A Conceptually Based Approach

Abstract

Objective Although multiple noncost factors likely influence a patient’s propensity to forego treatment in the face of cost pressures, little is known about how patients’ sociodemographic characteristics, physical and behavioral health comorbidities, and prescription regimens influence cost-related nonadherence (CRN) to medications. We sought to determine both financial and nonfinancial factors associated with CRN in a nationally representative sample of older adults. Methods We used a conceptual model developed by Piette and colleagues that describes financial and nonfinancial factors that could increase someone’s risk of CRN, including income, comorbidities, and medication regimen complexity. We used data from the 2004 wave of the Health and Retirement Study and the 2005 HRS Prescription Drug Study to examine the influence of factors within each of these domains on measures of CRN (including not filling, stopping, or skipping doses) in a nationally representative sample of Americans age 65+ in 2005. Results Of the 3071 respondents who met study criteria, 20% reported some form of CRN in 2005. As in prior studies, indicators of financial stress such as higher out-of-pocket payments for medications and lower net worth were significantly associated with CRN in multivariable analyses. Controlling for these economic pressures, relatively younger respondents (ages 65–74) and depressive symptoms were consistent independent risk factors for CRN. Conclusions Noncost factors influenced patients’ propensity to forego treatment even in the context of cost concerns. Future research encompassing clinician and health system factors should identify additional determinants of CRN beyond patients’ cost pressures.

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

“…Our finding differs from other studies that found no association between education and cost-related medication underuse. 13,35 The possible reasons for this include the different sample as well as the larger number of covariates, which may explain potential pathways for the effect of education. Berkowitz et al speculated that the lack of association between education and cost-related medication underuse may be attributable to people with chronic illness and lower education receiving assistance from prescription drug benefit programs.…”

Treatment duration with selective serotonin reuptake inhibitors among children and adolescents in Finland: a nationwide register study

“…Second, SSRIs may have been discontinued due to the high cost of ongoing treatment. Cost-related nonadherence is common among adults with depression or poor mental health [36][37][38]. However, all Finnish residents are entitled to receive at least 42% basic reimbursement for the costs of prescription drugs, including antidepressants, from the SII.…”

Updates to HRS Sample Weights

“…Results from one replication of analyses presented in a paper by Zivin et al (2010) are provided in Tables F1 and F2. The paper is based on respondents who participated in the 2005 Prescription Drug Study, a mail survey of a subsample of HRS respondents.…”