Compliance with medications lowers health care costs

Patients with inflammatory bowel disease (IBD) who take medications as directed have decreased medical costs, researchers from the University of Chicago researchers report at the American College of Gastroenterology annual scientific meeting in Las Vegas. A second study from the same group, however, suggests that there is no simple way to improve compliance.

In the first study, patients with mild to moderate ulcerative colitis who consistently took their medications -- in this case 5-aminosalicyclic acid (5-ASA) -- incurred 12.5 percent lower medical costs than those who did not.

"Patients with ulcerative colitis often struggle to comply with current 5-ASA treatments because they have to take multiple pills throughout the day," said study director Sunanda Kane, M.D., associate professor of medicine at the University of Chicago. "This study shows that following your doctor's advice, even when it's inconvenient, is worth the extra effort."

Using data from the from the Maryland CareFirst BlueCross BlueShield database, the researchers followed the progress of hundreds of patients who were new users of 5-ASA for an average of 332 days.

To determine which patients were most compliant and how that affected costs, the researchers compared data on prescription refills, costs and outcomes from 4,947 pharmacy and medical claims from 2002 through 2004. Patients who refilled their prescriptions within 15 days of the instructed date and did not switch to another drug were considered consistently compliant.

"We learned two things," said Kane. "First, compliance was poor overall, and second, compliance matters."

Compliance was "unimpressive" in all groups, she said, "and patients pay the price in terms of worse health and increased costs of care."

Compliance rates were similar for males and females, but the old and the young scored poorly. Fifty-seven percent of patients between 40 and 64 met the standard, followed by 55 percent for those between 18 and 40. For those over 65, compliance fell to 41 percent and for those under 18, to 35 percent.

Non-compliance resulted in higher total healthcare costs for all types of medical services. Costs were 32 percent higher for inpatient services and 44 percent for outpatient costs.

"What if we could simplify a patient's regimen with a reduced pill burden, ideally a once-daily treatment-" Kane and colleagues wondered. "Would patients be more likely to comply, and would that lower health care expenses?"

She is currently testing that theory in a study of once-daily 5-ASA.

While the impact of a once-daily regimen on compliance is being studied, a second report from Kane and colleagues, however, suggests that improving compliance will require much more than simply reducing the pill count. When they studied prescription refills among 1,680 patients with ulcerative colitis, they found that the number of prescribed pills per day had no effect on compliance.

The researchers followed patients on one of four slightly different regimens - none of them once a day - that involved taking 4, 6, 9 or 16 pills a day.

All four groups had steadily declining compliance for the first three months. Compliance, as measured by prescription refill rates, decreased by about twelve percent per month for the first three months, falling from 100 percent at the beginning to about 65 percent after three months. After three months they leveled off, decreasing only by about one percent per month for the next nine months.

"What it all means," Kane said, "is that we have a lot more to learn about patient behaviors and motivations."