Cubic News

Money down the drain – nobody benefits from non-adherence

July 2011

While drugs have the power to cure disease, manage symptoms and improve quality of life, according to the World Health Organization, only 50% of people taking long-term therapies for chronic conditions actually take their medication as prescribed.[1]  Whatever the reason may be, if plan members are not adhering to their medication regimens, there is little chance that their treatments will work to achieve clinical targets.  Furthermore, this behaviour also has the potential to have profound financial implications:  a 2007 study of 2,112 antidepressant users within a plan of 51,700 employees concluded that had these 2,112 claimants been adherent to their medication, the plan would have saved $400,000 in short term disability workdays.[2]

Depression is of particular concern for plan sponsors for several reasons:

• A study in the US estimated that depression resulted in 27.2 lost workdays per depressed claimant each year.[3]
• Cubic Health research on transactional drug claims for over 25,000 unique claimants between 2008 and 2010 showed that depressed claimants cost the plan three times as much for three times as many prescription drug claims in any given year compared to non-depressed claimants.  This utilization is driven by other related, concomitant conditions to their depression (e.g. anxiety, sleep disorders, high blood pressure, etc.)
• The nature of the condition actually predisposes patients to be among the most likely to not take their medication(s):  a recent study found that patients with depression were 1.8 times more likely to be non-adherent to medications compared to those with other conditions.[4]

 
Modern day antidepressants are among some of the most common drugs used today and have demonstrated excellent benefit in dealing with depression, with one caveat:  for these medications to work, they must be taken properly for a minimum of six months to one year before stopping therapy.  With many patients having a hard time taking a short seven-day course of antibiotics properly, it is not surprising that many patients fall off their medication regimens within the first six months.

While depressed claimants already lead to more direct drug plan costs in terms of increased utilization, their adherence to medication – or lack thereof – can also have significant implications on other, indirect costs for these claimants.  In a 2010 study, for example, employees adherent to their antidepressant treatment had significantly lower absenteeism costs ($3,857) compared to those who were non-adherent ($4,907).[5]  In other words, taking these kinds of therapies properly helps to keep employees at work and as productive as possible – arguably the two primary objectives for Canadian plan sponsors who provide prescription drug coverage as a benefit for their employees.

The question now becomes:  how adherent are your plan members?

 References:

[1] World Health Organization. Adherence to long-term therapies: evidence for action. Accessed July 12, 2011. Available at: http://www.who.int/chp/knowledge/publications/ adherence_full_report.pdf

[2] Burton WN, Chen CY, Conti DJ, et al. The association of antidepressant medication adherence with employee disability absence. Am J Manag Care. 2007;13:105–112.

[3] Kessler RC, Akiskal HS, Ames M, et al. Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. Am J Psychiatry. 2006;163:1561–1568.

[4] Grenard JL, Munjas BA, Adams JL, et. al. Depression and Medication Adherence in the Treatment of Chronic Diseases in the United States: A Meta-Analysis. J Gen Intern Med. 2011; DOI: 10.1007/s11606-011-1704-y.

[5] Birnbaum HG, Ben-Hamadi R, Kelley D, et. al. Assessing the Relationship Between Compliance With Antidepressant Therapy and Employer Costs Among Employees in the United States. JOEM. 2010; 52-2: 115-124.

 

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