What is the True Cost of Medication Nonadherence?

It is often said that medication nonadherence in the United States costs the health care system $300 billion annually, particularly by companies invested in improving adherence.

After all, health care is a business, and nothing sounds more appealing to investors than a large untapped market. But where did that $300 billion really come from?

In 2012, a review was published in The Annals of Internal Medicine titled "Interventions to Improve Adherence to Self-Administered Medications for Chronic Diseases in the United States: A Systematic Review."¹ The review did not analyze the cost of nonadherence. Rather, it identified papers that had addressed it, which included other reviews and related studies. The actual statement from the researchers is that "nonadherence has been estimated to cost the US health care system between $100 billion and $289 billion annually." So, a lowball estimate was $100 billion at the time. Considering that the studies mentioned were published all in the early 2000s with the most recent being 2009, it seems probable that even that estimate may be slightly off.

For that reason, a recent paper published in The Annals of Pharmacotherapy titled "Cost of Prescription Drug-Related Morbidity and Mortality" caught my attention, as it appeared to be an update of the cost of medication nonadherence and associated items.² The research was aimed at updating "the estimated cost of drug-related morbidity and mortality resulting from nonoptimized medication therapy."

Before getting into the researchers' methods and results, 1 thing that the authors mentioned in their introduction is worth noting: "Although widely misdescribed in the published literature and policy documents as the cost associated with 'patient nonadherence to medications,' this estimate and the preceding estimates actually reflect medical resource utilization caused by [treatment failures (TF)] and [new medical problems] that arise from nonoptimized medication use. Nonadherence to the indicated medication regimen is just 1 of multiple potential causal factors leading to a TF, resulting in downstream health services use."

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