Breaking patient compliance down to simplest terms
It may seem simple and perhaps obvious, but Mike Pucci, vice president external advocacy at GSK, says to ensure patient adherence programs drive behavior changes, its important to first understand what drives adherence. Simple but true.
Pucci told attendees at eyeforpharmas recent Patient Adherence and Persistence USA Summit that despite ongoing cries to the contrary, prescription medicines account for only about 10% of total healthcare expenditures in the US just, he says, as they have for the past 40 years or so. Hospital care ranks as the top expenditure at 31% of the $2.1 trillion total spent on healthcare in the US in 2006, while diagnostics and other procedures accounted for 25% of the total spend.
Pharmaceutical products, as Pucci points out, have the unique ability, however, to help actually reduce spending on hospital stays, diagnostics and physician costs. The key in reducing healthcare cost, he says, is striving to prevent disease and illness.
One or more of five chronic diseases cardiovascular disease, diabetes, smoking-related respiratory conditions (COPD, allergies and asthma), cancer, and mental illness/depression affect 49% of all Americans, Pucci says. At least one of these conditions is seen in 85% of the elderly, 45% of working age adults and 23% of children. And 75% of all healthcare spending goes to treat these chronic diseases, Pucci reports.
Were not investing to keep people healthy, were treating them instead, he says. Were not offering the necessary incentives to keep people out of the healthcare system in the first place.
The obesity rate, which drives two of the top three chronic disease states, more than doubled from 1995 to 2005 in the US, Pucci says, and the incidence of diabetes is following the same trend. More than 64% of US adults are overweight or obese and the rate of Type 2 diabetes in children has increased as much as 10 times over the past two decades.
The numbers are overwhelming, Pucci says, but, in the face of those numbers, perhaps more worrisome is a conclusion from the World Health Organization that adherence to long-term therapy for chronic diseases in developed countries averages 50%. The consequences, the group stresses are poor healthcare outcomes and increased healthcare costs.
Independent industry surveys prove the point. Prescription insurance providers Caremark and Medco, in recent studies, both concluded that their plan participants with lower prescription medication adherence rates had higher total healthcare costs.
So why dont we link the two together and pay attention to this? Pucci asks.
GSK's own research, he says, demonstrates that the two biggest deterents to patient compliance with prescription therapies are side effects and out of pocket cost.
Although a patient that is less than 20% compliant spends less on prescription medication, his overall healthcare costs are higher than a patient who is 80% or more compliant, even though his prescription medications cost more. As simple as it may seem, improving medication compliance is a key driver in decreasing medical costs, Pucci says. And although its a simple and seemingly obvious conclusion, its largely overlooked or ignored, he says.
He points to several case study examples. The Asheville project is an increasingly popular example. In this mountain town in North Carolina, 172 diabetes patients were driving the lions share of healthcare costs for the city. In response, Asheville changed its benefits design to address peoples lack of understanding of their condition and compliance, as evidenced by an average 15% refill rate of their diabetes medications.
Pucci says the town brought people in and set up disease management and compliance programs that and agreed to make their medications free if they complied with the programs, which included one-on-one interventions with pharmacists and physicians. And although the citys spend on medications increased, over time their overall spend on healthcare was dramatically reduced. Today, refill rates for diabetes patients in Asheville are 95%, Pucci says, and sick days away from work are dramatically reduced.
The program was so successful that the town took a similar approach with asthma patients and saw similar results.
The program has been recreated with hypertension and cholesterol patients in Minnesota, using medication therapy management approaches, with equally impressive results. Compliance rates with hypertension patients rose from 59% to more than 71% and from 30% in cholesterol patients to more than 52%.
And once again, although expenditures on prescription rose, total healthcare costs dramatically declined, Pucci says. In fact, Minnesota reports that its return on investment from its medication therapy management programs is 12 to one.
As its healthcare costs were skyrocketing, the Pitney Bowes corporation, Pucci says, lowered medication copays for workers affected with diabetes and asthma to just 10%, leading to better treatment for its workers and a much improved bottom line. Overall medical costs for its employees with diabetes dropped 12%, while costs for asthma patients dropped 15%. Much of the savings could be attributed to declines in the cost of emergency room visits, down 35% for diabetes patients and 20% for asthma patients.
Its time we started thinking differently about the value of medicines and stop apologizing about the cost of prescription drugs, Pucci says. After all, statins cost about $3 a day. How does that compare to what most of us spend on a coffee at Starbucks?