Cost may be common factor in drug nonadherence among patients with chronic liver disease
About 25% of 3,237 respondents with chronic liver disease in the National Health Interview Survey from 2014 through 2018 reported not taking their medications as prescribed due to cost.
Patients with chronic liver disease may often avoid adhering to their medication regimens because of cost, according to a recent study.
Researchers used data from the National Health Interview Survey to estimate the prevalence, risk factors, and consequences of cost-related medication nonadherence in U.S. patients with chronic liver disease. They used complex weighted survey analysis to obtain national estimates and risk factors for cost-related nonadherence and its association with cost-reducing behaviors and measures of financial toxicity, such as financial hardship due to medical bills, financial distress, and food insecurity. The results were adjusted for age, sex, race/ethnicity, insurance, income, education, and comorbid conditions. The study results were published online on June 10 by Mayo Clinic Proceedings.
From Jan. 1, 2014, to Dec. 31, 2018, there were 3,237 survey respondents with chronic liver disease. Forty-eight percent were men, and 67% were of non-Hispanic White ethnicity. Eight hundred thirteen patients (25%; 95% CI, 23% to 27%) reported cost-related nonadherence, and 68% of this group reported maladaptive cost-reducing behaviors. Higher prevalence of cost-related nonadherence was associated with younger age, female sex, low income, and multimorbidity. Patients with cost-related nonadherence had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 5.05; 95% CI, 3.73 to 6.83), food insecurity (aOR, 2.85; 95% CI, 2.02 to 4.01), and ED visits (aOR, 1.46; 95% CI, 1.11 to 1.94) than those without.
The authors noted that data on liver disease were self-reported and that disease severity could not be determined, among other limitations. They concluded that cost-related nonadherence is common among patients with chronic liver disease, as are associated consequences, such as financial distress, financial hardship due to medical bills, food insecurity, maladaptive cost-reducing strategies, increased health care use, and work absenteeism among patients. “Given the impact of these risk factors on maladaptive coping, treatment-related decision making, and unplanned health care use, our study highlights the importance of screening for [cost-related nonadherence] as standard of care in all patients with [chronic liver diseases],” the authors wrote.