Study proves that even with increased drug costs, adherence will reduce overall health spending

It is widely accepted that patients who are adherent to their regimens are likely to use fewer health resources and cost the healthcare-delivery system less. But a new study, “Medication Adherence Leads To Lower Health Care Use And Costs Despite Increased Drug Spending”, conducted by CVS Caremark and published in Health Affairs, confirmed these benefits of adherence. The study found that among patients who had increased drug costs but were adherent with their medications, a “substantial medical savings as a result of reductions in hospitalization and emergency department use” was realized.

Authors Roebuck, Liberman, Gemmill-Toyama, and Brennan performed their research through an investigation of integrated pharmacy and medical administrative CVS Caremark claims data collected from individuals with continuous insurance coverage from January 1, 2005, through June 30, 2008. The authors stated that previous adherence studies - observation-based research with unobserved and therefore unmeasurable variables - were unable to establish a causal link between medication adherence and lowered use and costs. The CVS Caremark study was performed using a combination of data and methods, which, the authors reported, “allowed us to move from possibly uncovering statistical associations to more confidently inferring causal link between medication adherence and the use and cost of health care.”

The study reviewed the data of 135,008 individuals having 1 of 4 chronic cardiovascular conditions: congestive heart failure, hypertension, diabetes, and dyslipidemia. Using the medication possession ratio (MPR) and other measures, patient adherence was measured and found to reduce total annual healthcare spending for people with chronic vascular disease. The savings in annual medical spending of hospital inpatient days, emergency department visits, and outpatient medical office visits were compared between adherent and nonadherent patients. Savings by adherent patients were dramatically illustrated in each group: $8,881 in congestive heart failure, $4,337 in hypertension, $4,413 in diabetes, and $1,860 in dyslipidemia. The authors’ expectation that adherent patients had higher pharmacy expenditures was confirmed, with $1,058 more spent by patients with congestive heart failure, $429 for hypertension, $656 for diabetes, and $601 for dyslipidemia.

The benefit-cost ratios were noticeably higher in patients over 65, and the investigators conclude that payor-based programs designed to improve adherence, especially in populations aged 65 years and older with chronic disease, can deliver valuable savings. The Affordable Care Act of 2010 cited reducing nonadherence in the elderly as a focal point, and the authors encouraged the implementation of programs that promoted adherence, provided the program costs did not exceed the cost of savings, and cited the use of electronic monitoring devices and pharmacist counseling as low-cost, beneficial interventions.

The full article is available (by subscription) through Health Affairs at http://content.healthaffairs.org/content/30/1/91.full.html.