Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017

Research output: Contribution to journalArticle

Rohan Khera, Javier Valero-Elizondo, Sandeep R. Das, Salim S. Virani, Bita A. Kash, James A. de Lemos, Harlan M. Krumholz, Khurram Nasir

BACKGROUND: Medication nonadherence is associated with worse outcomes in patients with atherosclerotic cardiovascular disease (ASCVD), a group who requires long-term therapy for secondary prevention. It is important to understand to what extent drug costs, which are potentially actionable factors, contribute to medication nonadherence. METHODS: In a nationally representative survey of US adults in the National Health Interview Survey (2013-2017), we identified individuals ≥18 years with a reported history of ASCVD. Participants were considered to have experienced cost-related nonadherence (CRN) if in the preceding 12 months they reported skipping doses to save money, taking less medication to save money, or delaying filling a prescription to save money. We used survey analysis to obtain national estimates. RESULTS: Of the 14 279 surveyed individuals with ASCVD, a weighted 12.6% (or 2.2 million [95% CI, 2.1-2.4]) experienced CRN, including 8.6% or 1.5 million missing doses, 8.8% or 1.6 million taking lower than prescribed doses, and 10.5% or 1.9 million intentionally delaying a medication fill to save costs. Age <65 years, female sex, low family income, lack of health insurance, and high comorbidity burden were independently associated with CRN, with >1 in 5 reporting CRN in these subgroups. Survey respondents with CRN compared with those without CRN had 10.8-fold higher odds of requesting low-cost medications and 8.9-fold higher odds of using alternative, nonprescription, therapies. CONCLUSIONS: One in 8 patients with ASCVD reports nonadherence to medications because of cost. The removal of financial barriers to accessing medications, particularly among vulnerable patient groups, may help improve adherence to essential therapy to reduce ASCVD morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)2067-2075
Number of pages9
JournalCirculation
Volume140
Issue number25
DOIs
StatePublished - Dec 17 2019

PMID: 31760784

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Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017. / Khera, Rohan; Valero-Elizondo, Javier; Das, Sandeep R.; Virani, Salim S.; Kash, Bita A.; de Lemos, James A.; Krumholz, Harlan M.; Nasir, Khurram.

In: Circulation, Vol. 140, No. 25, 17.12.2019, p. 2067-2075.

Research output: Contribution to journalArticle

Harvard

Khera, R, Valero-Elizondo, J, Das, SR, Virani, SS, Kash, BA, de Lemos, JA, Krumholz, HM & Nasir, K 2019, 'Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017' Circulation, vol. 140, no. 25, pp. 2067-2075. https://doi.org/10.1161/CIRCULATIONAHA.119.041974

APA

Khera, R., Valero-Elizondo, J., Das, S. R., Virani, S. S., Kash, B. A., de Lemos, J. A., ... Nasir, K. (2019). Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017. Circulation, 140(25), 2067-2075. https://doi.org/10.1161/CIRCULATIONAHA.119.041974

Vancouver

Khera R, Valero-Elizondo J, Das SR, Virani SS, Kash BA, de Lemos JA et al. Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017. Circulation. 2019 Dec 17;140(25):2067-2075. https://doi.org/10.1161/CIRCULATIONAHA.119.041974

Author

Khera, Rohan ; Valero-Elizondo, Javier ; Das, Sandeep R. ; Virani, Salim S. ; Kash, Bita A. ; de Lemos, James A. ; Krumholz, Harlan M. ; Nasir, Khurram. / Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017. In: Circulation. 2019 ; Vol. 140, No. 25. pp. 2067-2075.

BibTeX

@article{2f1640d7898545a29d797a62241c64d3,
title = "Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017",
abstract = "BACKGROUND: Medication nonadherence is associated with worse outcomes in patients with atherosclerotic cardiovascular disease (ASCVD), a group who requires long-term therapy for secondary prevention. It is important to understand to what extent drug costs, which are potentially actionable factors, contribute to medication nonadherence. METHODS: In a nationally representative survey of US adults in the National Health Interview Survey (2013-2017), we identified individuals ≥18 years with a reported history of ASCVD. Participants were considered to have experienced cost-related nonadherence (CRN) if in the preceding 12 months they reported skipping doses to save money, taking less medication to save money, or delaying filling a prescription to save money. We used survey analysis to obtain national estimates. RESULTS: Of the 14 279 surveyed individuals with ASCVD, a weighted 12.6{\%} (or 2.2 million [95{\%} CI, 2.1-2.4]) experienced CRN, including 8.6{\%} or 1.5 million missing doses, 8.8{\%} or 1.6 million taking lower than prescribed doses, and 10.5{\%} or 1.9 million intentionally delaying a medication fill to save costs. Age <65 years, female sex, low family income, lack of health insurance, and high comorbidity burden were independently associated with CRN, with >1 in 5 reporting CRN in these subgroups. Survey respondents with CRN compared with those without CRN had 10.8-fold higher odds of requesting low-cost medications and 8.9-fold higher odds of using alternative, nonprescription, therapies. CONCLUSIONS: One in 8 patients with ASCVD reports nonadherence to medications because of cost. The removal of financial barriers to accessing medications, particularly among vulnerable patient groups, may help improve adherence to essential therapy to reduce ASCVD morbidity and mortality.",
keywords = "atherosclerosis, cardiovascular disease, costs and cost analysis, medication adherence",
author = "Rohan Khera and Javier Valero-Elizondo and Das, {Sandeep R.} and Virani, {Salim S.} and Kash, {Bita A.} and {de Lemos}, {James A.} and Krumholz, {Harlan M.} and Khurram Nasir",
year = "2019",
month = "12",
day = "17",
doi = "10.1161/CIRCULATIONAHA.119.041974",
language = "English (US)",
volume = "140",
pages = "2067--2075",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "25",

}

RIS

TY - JOUR

T1 - Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017

AU - Khera, Rohan

AU - Valero-Elizondo, Javier

AU - Das, Sandeep R.

AU - Virani, Salim S.

AU - Kash, Bita A.

AU - de Lemos, James A.

AU - Krumholz, Harlan M.

AU - Nasir, Khurram

PY - 2019/12/17

Y1 - 2019/12/17

N2 - BACKGROUND: Medication nonadherence is associated with worse outcomes in patients with atherosclerotic cardiovascular disease (ASCVD), a group who requires long-term therapy for secondary prevention. It is important to understand to what extent drug costs, which are potentially actionable factors, contribute to medication nonadherence. METHODS: In a nationally representative survey of US adults in the National Health Interview Survey (2013-2017), we identified individuals ≥18 years with a reported history of ASCVD. Participants were considered to have experienced cost-related nonadherence (CRN) if in the preceding 12 months they reported skipping doses to save money, taking less medication to save money, or delaying filling a prescription to save money. We used survey analysis to obtain national estimates. RESULTS: Of the 14 279 surveyed individuals with ASCVD, a weighted 12.6% (or 2.2 million [95% CI, 2.1-2.4]) experienced CRN, including 8.6% or 1.5 million missing doses, 8.8% or 1.6 million taking lower than prescribed doses, and 10.5% or 1.9 million intentionally delaying a medication fill to save costs. Age <65 years, female sex, low family income, lack of health insurance, and high comorbidity burden were independently associated with CRN, with >1 in 5 reporting CRN in these subgroups. Survey respondents with CRN compared with those without CRN had 10.8-fold higher odds of requesting low-cost medications and 8.9-fold higher odds of using alternative, nonprescription, therapies. CONCLUSIONS: One in 8 patients with ASCVD reports nonadherence to medications because of cost. The removal of financial barriers to accessing medications, particularly among vulnerable patient groups, may help improve adherence to essential therapy to reduce ASCVD morbidity and mortality.

AB - BACKGROUND: Medication nonadherence is associated with worse outcomes in patients with atherosclerotic cardiovascular disease (ASCVD), a group who requires long-term therapy for secondary prevention. It is important to understand to what extent drug costs, which are potentially actionable factors, contribute to medication nonadherence. METHODS: In a nationally representative survey of US adults in the National Health Interview Survey (2013-2017), we identified individuals ≥18 years with a reported history of ASCVD. Participants were considered to have experienced cost-related nonadherence (CRN) if in the preceding 12 months they reported skipping doses to save money, taking less medication to save money, or delaying filling a prescription to save money. We used survey analysis to obtain national estimates. RESULTS: Of the 14 279 surveyed individuals with ASCVD, a weighted 12.6% (or 2.2 million [95% CI, 2.1-2.4]) experienced CRN, including 8.6% or 1.5 million missing doses, 8.8% or 1.6 million taking lower than prescribed doses, and 10.5% or 1.9 million intentionally delaying a medication fill to save costs. Age <65 years, female sex, low family income, lack of health insurance, and high comorbidity burden were independently associated with CRN, with >1 in 5 reporting CRN in these subgroups. Survey respondents with CRN compared with those without CRN had 10.8-fold higher odds of requesting low-cost medications and 8.9-fold higher odds of using alternative, nonprescription, therapies. CONCLUSIONS: One in 8 patients with ASCVD reports nonadherence to medications because of cost. The removal of financial barriers to accessing medications, particularly among vulnerable patient groups, may help improve adherence to essential therapy to reduce ASCVD morbidity and mortality.

KW - atherosclerosis

KW - cardiovascular disease

KW - costs and cost analysis

KW - medication adherence

UR - http://www.scopus.com/inward/record.url?scp=85076874254&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076874254&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.119.041974

DO - 10.1161/CIRCULATIONAHA.119.041974

M3 - Article

VL - 140

SP - 2067

EP - 2075

JO - Circulation

T2 - Circulation

JF - Circulation

SN - 0009-7322

IS - 25

ER -

ID: 56846160