Longitudinal Patterns of Medication Nonadherence and Associated Health Care Costs

Abstract

Background Non-adherence to treatment recommendations is associated with poorer outcomes in inflammatory bowel disease and may increase the cost of care. We examined the longitudinal relationship between non-adherence and health care costs and hypothesized that at least three distinct trajectories of non-adherence would be observed, and that increasing non-adherence would account for significantly greater health care costs after controlling for disease activity. Methods Ninety-nine patients 2–21 years of age with inflammatory bowel disease were recruited into this two-year longitudinal study. Medication possession ratios were calculated from pharmacy refill data, disease activity ratings were obtained from medical charts, and hospital and physician charges associated with an ICD-9 code for ulcerative colitis or Crohn’s disease were obtained from the hospital’s accounting database. Results An average total costs d = .68 effect size was observed between the increasing severity and stable low severity groups, but the CIs overlap. Conversely, patients with increasing non-adherence demonstrated significantly higher health care costs than patients with stable ≤ 10%, stable 11–20% or decreasing non-adherence. Conclusions Medication non-adherence is related to increased health care costs after controlling for disease severity. Patients with increasing non-adherence over time demonstrate more than a 3-fold increase in costs compared to adherent patients. Additionally, patients whose adherence improves over time incur approximately the same costs as those who are consistently adherent. This suggests that, in addition to leveraging prevention efforts to keep patients from becoming more non-adherent as treatment continues, efforts aimed at modifying adherence behavior may result in significant cost savings over time.

Longitudinal non‐adherence predicts treatment escalation in paediatric ulcerative colitis

“…Of note, the PROTECT study used a relatively high mesalazine dosing schedule of about 67 mg/kg per day (maximum 4 g) compared to previous paediatric studies. Treatment escalation due to relapse is a common consequence of non‐adherence in youth with IBD and can result in increased morbidity as well as increased costs to the healthcare system and family . Importantly, declining or suboptimal adherence to maintenance medication is not a basis for treatment escalation; rather, the decision to escalate treatment is based on disease response (or lack of response) to maintenance medication.…”

“…Treatment escalation due to relapse is a common consequence of non-adherence in youth with IBD 33 and can result in increased morbidity 21 as well as increased costs to the healthcare system and family. 3,4 Importantly, declining or suboptimal adherence to maintenance medication is not a basis for treatment escalation; rather, the decision to escalate treatment is based on disease response (or lack of response) to maintenance medication. Given the emphasis on achieving optimal nutrition, growth and development in this population, treatment escalation from 5-ASA is often indicated to promote mucosal healing and avoid steroid dependence.…”

“…Medication non‐adherence in youth with chronic conditions can lead to disease progression and poor treatment outcomes, unnecessary healthcare utilisation and higher healthcare costs . In youth with inflammatory bowel diseases (IBD), medication non‐adherence has also been associated with increased healthcare costs and negative health outcomes, including more frequent flares in disease activity and greater colorectal cancer risk . Research has also associated poor adherence with negative psychosocial outcomes in children and adolescents, including anxiety and depression symptoms and lower health‐related quality of life in those with IBD .…”

“…2 In youth with inflammatory bowel diseases (IBD), medication non-adherence has also been associated with increased healthcare costs and negative health outcomes, including more frequent flares in disease activity and greater colorectal cancer risk. [3][4][5][6] Research has also associated poor adherence with negative psychosocial outcomes in children and adolescents, including anxiety and depression symptoms and lower health-related quality of life in those with IBD. [7][8][9][10] Rates of medication non-adherence in paediatric IBD range from 2% to 93%, and non-adherence is higher in adolescents compared to younger youth.…”

Advancing the Science and Practice of Medication Adherence

“…This misses the fact that medication adherence in chronic conditions may vary in response to disease activity, treatment methods, and the course of psychosocial comorbidities. Longitudinal data has identified a tendency for regimen implementation to decline over time 18 , 19 , as well as distinct longitudinal patterns of medication use among patient subgroups (i.e., dose-taking that is consistently high, consistently low, increasing, decreasing, or variable) [20][21][22] . A large HIV patient cohort showed high regimen implementation over extended intervals, but 48% of patients had at least one 6-month period of low adherence over a median 4.5 years of follow-up 23 .…”