Capgemini put together an interesting report on medication adherence, which has some quantitative aspects but was largely constructed from surveys of over 60 executives in life sciences, provider and payer organizations. (CapGem Report) The report reiterates claims that non-adherence costs over $300 billion a year in unnecessary health spending, including almost $200 billion in hospital inpatient spending. The report on which this was based is non-credible, since it assumes all costs related to a non-compliant patient would have been avoided if they had just been compliant. The firm also estimates that non-adherence costs drug companies over $180 billion in annual revenue. You might have to subtract that from the hypothetical savings! Non-adherence is a serious quality issue and the report is on sounder footing in noting the complexity of the issue and the difficulty of solving its multi-factorial causes.
Patients are non-adherent for a variety of reasons, including cost and side effects (which are often minimized by manufacturers in the development and marketing process). Because of the complex nature of the problem, addressing it in a meaningful way can be expensive which limits any return on the cost of creating better adherence. From a quality perspective, however, it is very important to ensure that if a drug can help a patient, the patient gets the drug and uses it according to the physician’s directions, and that there is ongoing management of the therapy to ensure that the drug is working as intended and any side effects are minimized. Educating patients and physicians, eliminating cost barriers, matching drug administration and dose to the individual patient needs and accounting for socio-demographic issues is not free and while some savings in other services might be expected, it does not seem logical to expect that the cost of achieving adherence and paying for the additional drug use is going to create large savings.