The Cost Of Non-optimized Medications

Researchers at the University of California (UC) San Diego estimate that illness and death resulting from non-optimized medication therapy costs $528.4 billion annually, equivalent to 16 percent of total U.S. healthcare expenditures in 2016.

“Ideally, when you’re sick, a healthcare professional prescribes you a medication, you take it as directed, and you get better,” said Jonathan Watanabe, PharmD, PhD. “But what happens a lot of the time is the medication regimen is not optimized. In other words, the prescription may not be exactly appropriate for your indication—not quite the right medication or dose—or you just don’t take the medication for whatever reason, don’t take them as directed, or the medication causes an adverse event or a new health problem.”

For example, you come down with the flu and visit the emergency room. A doctor prescribes Tamiflu, but you don’t fill the prescription. Your symptoms worsen and you end up back at the hospital—all at great cost to you, the hospital, and your insurance company.

Clark was working in a cake shop with plans to enroll in a culinary arts program.

But the problem isn’t just nonadherence (not taking the medication at all or not taking it as directed), Watanabe said. Non-optimized medication therapy also includes instances in which a medication contributes to a new health problem. For example, the ACE inhibitor you’re taking to lower your blood pressure causes you to cough, so you take an over-the-counter cough-and-cold medicine that also includes an ingredient that increases blood pressure and raises your risk of sleepiness and falls.

“In that case, the drug treatment is functioning like a new disease,” said Jan Hirsch, PhD, who participated in the research.

For the study, published in the Annals of Pharmacotherapy, the researchers considered many health outcomes that could ensue due to a treatment failure or new treatment-caused medical problem, including emergency department visits, hospitalization, long-term care, medical appointments, and additional medications. They estimated that the average cost of an individual experiencing treatment failure, a new medical problem, or both after initial prescription use to be approximately $2,500. The estimates did not include non-medical costs such as transportation or caregiving, or indirect costs related to lost productivity.

“Non-optimized medication therapy is a massive avoidable cost,” Watanabe said. “If medications were prescribed, monitored, and taken properly, we wouldn’t face this cost, and patients would be healthier.”

This article was adapted from information provided by UC San Diego.

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