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Jan D. Hirsch, BSPharm, PhD, and Candis M. Morello, PharmD, CDE
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Strategies for Addressing the Cost of Nonadherence in Diabetes
Candis M. Morello, PharmD, CDE, and Jan D. Hirsch, BSPharm, PhD
Utilizing Advances in Diabetes and Targeting Medication Adherence to Enhance Clinical Outcomes and Manage Costs for Type 2 Diabetes Posttest

Strategies for Addressing the Cost of Nonadherence in Diabetes

Candis M. Morello, PharmD, CDE, and Jan D. Hirsch, BSPharm, PhD
Diabetes accounts for the second largest amount of avoidable healthcare costs in the United States—an estimated $24.6 billion in wasteful and avoidable spending. Diabetes is a lifelong disease that is highly dependent on patient self-management. Unfortunately, studies demonstrate that almost 50% of patients with diabetes fail to reach the glycemic goal of glycated hemoglobin <7%. Patient nonadherence poses a significant barrier to effective management of diabetes and can place a significant burden on the patient and the healthcare system, resulting in even greater increases in costs, morbidity, and mortality. Therefore, effective treatment and long-term management of diabetes requires a patient-centered collaborative model of care with an understanding of the factors associated with nonadherence. This may help develop patient-, provider-, and system-focused strategies to help increase the rates of medication adherence, reduce complications associated with uncontrolled diabetes, and lower the overall cost of management.
Am J Manag Care. 2017;23:-S0
Nearly 8%, or $213 billion, of total healthcare spending in the United States is considered wasteful and avoidable.1 About half of it, $105.4 billion per year, results from medication nonadherence to treat chronic diseases. Diabetes has been estimated to have the second highest impact, accounting for $24.6 billion in avoidable costs. Not included in this estimate are avoidable costs associated with diabetes-related complications and comorbidities, or conditions such as cardiovascular disease, for which diabetes is a major risk factor. Patient nonadherence to prescribed treatment can place a significant burden on the patient and the healthcare system, resulting in even greater increases in costs, morbidity, and mortality.1

High Costs Associated With Medication Nonadherence
Patient nonadherence is among the largest factors associated with poor outcomes in patients with type 2 diabetes (T2D), the most common form of those diagnosed with diabetes.2 The American Diabetes Association defines adequate adherence as 80% compliance (percentage of medications taken divided by the number of medications prescribed by the physician within a given time period).3 Approximately half of patients with T2D in their first year of therapy fail to take at least 80% of prescribed doses.4 Estimates show that 47.8% of adult patients with diabetes are not meeting the glycemic goal of glycated hemoglobin (A1C) <7%,5 illustrating that poor glycemic control in patients with T2D is very common.6 Conversely, clinical studies show that improved adherence is associated with improved glycemic control and decreased healthcare resource usage.7 Higher adherence has been shown to be associated with overall decreased costs, specifically lower acute care costs that lead to total cost reductions. Each 1% increase in adherence among 1000 patients with diabetes 65 years and older was associated with $65,464 all-cause cost savings over 3 years.8

The progressive nature of diabetes and the resulting lifelong dependence on medications pose important challenges for many patients and the healthcare system. Despite improvements in efficacy and safety of available medications, the challenge with adherence persists. Understanding the determinants of adherence may help develop patient-, provider-, and system-focused strategies to encourage and ensure improved adherence and ultimately clinical outcomes. Recent advances in technology may also help in easing the burden associated with nonadherence (eg, advances in insulin delivery systems [pens, pumps, continuous glucose monitoring, and closed-loop systems], methods for dose adjustments [bolus calculators and physician-directed smartphone apps], and a range of self-management apps).

Barriers to Medication Adherence
Patient medication adherence is a key component to effective treatment, and adherence to prescribed therapies can prevent or delay the onset of complications, reduce the risk of hospitalization, and decrease direct healthcare costs.1 Adherence goes beyond the passive act of following a prescriber’s recommendation. It includes an agreement by the patient to purchase the medication(s) and take the medication(s) according to the dose and schedule prescribed by the healthcare provider.9 However, lack of medication adherence is not always the fault of the patient. Barriers to adherence can be grouped into 3 general categories: patient factors, provider factors, and external factors (Table 13,9-13).9



 
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