Avoidable costs of more than $200 million are incurred each year in the US healthcare system as a result of medicines not being used responsibly by patients and healthcare professionals, according to new research from IMS.
This figure represents 8% of total US annual healthcare expenditures and amounts to millions of avoidable hospital admissions, outpatient treatments, drug prescriptions and emergency-room visits for patients, says the study, which is published by the IMS Institute for Healthcare Informatics.
The report examines the following six areas which contribute to unnecessary costs to the US healthcare system: medication non-adherence, delayed evidence-based treatment practice, misuse of antibiotics, medication errors, suboptimal use of generics and mismanaged polypharmacy in older adults. Together, these areas lead to unnecessary utilisation of healthcare resources involving an estimated 10 million hospital admissions, 78 million outpatient treatments, 246 million prescriptions and four million emergency-room visits annually, according to the study.
Avoidable costs arising from the non-optimal use of medicines could pay for the healthcare of more than 24 million US citizens who currently have no health insurance, commented Murray Aitken, executive director at the IMS Institute.
"Reaching a meaningful level of consensus and alignment among stakeholders, based on measured and proven success models, is a key step to unlocking the $200 billion opportunity identified in our study," he said.
The report updates existing published research and finds that progress is being made to address some of the challenges that drive wasteful spending in many parts of the US healthcare system. For example, medication adherence among large populations of patients with hypertension, hyperlipidemia and diabetes has improved 3%-4% since 2009.
In addition, the proportion of patients who are diagnosed with a cold or flu and who inappropriately receive antibiotic prescriptions has fallen from 20% to 6% since 2007. Also, patients are now receiving lower-cost generic alternatives to branded medications, when these are available, 95% of the time.
Medication non-adherence drives the largest avoidable cost in the system, the study finds; patients not adhering to their doctors' medication guidance experience complications leading to an estimated $105 billion in annual avoidable healthcare costs. The underlying reasons for non-adherence are varied and longstanding, but the growing use of analytics, plus collaboration among providers, pharmacists and patients, appear to be advancing both the understanding and effectiveness of intervention programmes, it says.
The study also estimates that delays in applying evidence-based treatment lead to annual avoidable costs totalling $40 billion. The researcher analysed four disease areas in which patients either are not diagnosed early or treatment is not initiated promptly, and found that the largest avoidable impact is in diabetes, where such delays increased outpatient visits and hospitalisations. A reduction in this source of avoidable costs is possible if insurance courage is expanded, and if at-risk patients are able to receive appropriate screening and diagnostic testing, it says.
The researchers also find some signs of improvement in the responsible use of antibiotics. Misuse of these drugs contributes to antimicrobial resistance and to an estimated $34 billion each year in avoidable inpatient care costs, while an additional $1 billion is misspent on about 31 million inappropriate antibiotic prescriptions dispensed each year in the US, typically for viral infections, they note. However, they find encouraging signs that efforts to drive responsible use of antibiotics are paying off, particularly in the declining number of prescriptions for the common cold and flu - these viral infections do not respond to antibiotics.
They also report that many efforts are underway in the US to address the underlying causes of avoidable spending and to improve medication use. A large number of initiatives are advancing across the healthcare landscape, including novel interventions, critical assessments of established solutions and pioneering models of stakeholder cooperation, they say. Moreover, many of these initiatives involve a greater role for pharmacists, an integrated approach to addressing patient issues, alignment of financial incentives and greater use of healthcare informatics to guide decision-making and monitor progress, says IMS.