Cost-related underuse of heart meds leads to cardiac complications

MANAGED CARE September 2004. ©MediMedia USA

Middle-aged and older Americans with heart disease who cut back on their prescribed medications because of cost were 50 percent more likely to suffer heart attacks, strokes, or angina than those who did not report cost-related medication underuse, according to the lead author, Michele Heisler, MD, MPA, and colleagues in a study conducted at the Veterans Affairs Ann Arbor Healthcare System in Michigan.

The study is significant because it is the first nationally representative longitudinal study to demonstrate that patients with serious chronic illnesses experience adverse health events when they restrict their use of prescription drugs due to cost. The downturns in patients' health were observed over a two- to three-year period, suggesting that cost barriers to prescription drug use may have important short-term effects on older patients' health and well-being.

"Managed care organizations need to be a little more creative about incorporating patients' clinical need for the medication. Insurers need to make sure that the people who most need the medicine are not experiencing cost barriers to taking it," says Heisler.

"Physicians need to be sensitive to the effect cost has on patient adherence as well," continues Heisler. "We need to be asking patients and making sure cost is not such a burden."

After controlling for risk factors for poor health outcomes, 32 percent of adults who had restricted medications because of cost pressures reported a significant decline in their self-reported health status during their follow-up interviews compared to 21 percent of adults with no cost-related underuse. Patients' reports on their health have been found to strongly predict other serious life events, including mortality, according to the study. Researchers found that people with arthritis and diabetes who said they had restricted drug use due to cost did not report that the condition had worsened, unlike the cardiovascular patients.

Medication underuse due to high cost results in higher rates of cardiac events

Incidence of adverse health events among patients with serious chronic illnesses , adjusted for risk factors

SOURCE: MEDICAL CARE, "HEALTH EFFECTS OF COST-RELATED MEDICATION RESTRICTION" 2004 JUL;42(7):623-5.