Half a trillion dollars a year in global health spending can be avoided if health system stakeholders use medicines more responsibly and align their capabilities, resources and activities more strongly, according to a new report.

The health spending which can be avoided in this way amounts to 8% of total annual health expenditures worldwide, and more than half of this can be gained through improved patient adherence, according to the report. 

The report has been produced by the IMS Institute for Healthcare Informatics and presented at an international summit for Health Ministers held during the International Pharmaceutical Federation (FIP) centennial congress, in Amsterdam this week.

The World Health Organization (WHO) and the IMS Institute were asked by the Dutch Health Ministry to identify priority areas for supporting more responsible use of medicines. In its response, WHO estimates that more than half of medicines are not taken correctly because they may be prescribed, dispensed or sold inappropriately, and patients may take them incorrectly. This is in addition to those patients who do not receive the right medicine - or any medicine - in a timely manner. 

The IMS Institute report highlights six specific levers of opportunity to improve the use of medicines, namely: increasing patient adherence; ensuring timely medicine use; optimising antibiotic use; preventing medication errors; using low-cost generics where available; and managing polypharmacy.

Improvements in patient adherence make up more than half - $269 billion - of the $500 billion annual opportunity, it says.

The report includes five recommendations for health ministers and other health system leaders to implement in order to drive improvements. These are: support a greater role for pharmacists in medicines management; invest in medical audits that focus on elderly patients; implement mandatory reporting of antibiotic use; encourage a 'no blame' culture toward error reporting; and support targeted disease management programmes for prevalent, noncommunicable diseases.

The report which WHO has produced for the Ministers examines the experiences and learnings from various countries, and makes the following six strategic recommendations:

- develop and mandate a List of Essential Medicines at the national level to inform reimbursement decisions and ensure access to essential medicines;

- invest to ensure national medicines procurement and supply systems are efficient and reliable to support the responsible use of medicines;

- promote a shift in focus to early screening and accurate diagnosis to guide/inform medicines prescribing and avoid overuse, underuse and misuse of medicines:

- facilitate the implementation of evidence-based treatment guidelines. Remove regulatory or administrative barriers, where they exist, and directly target all key stakeholders - prescribers, dispensers and patients;

- promote initiatives that put patients at the centre of treatment, in order to maximise adherence to therapy; and

- monitor medicine use, from purchase to health outcome, to evaluate the real-world efficacy of treatment and guide evidence-based policymaking.

"The actions that are outlined in the two reports are pragmatic, measurable and proven to bring positive impact," said IMS Institute executive director Murray Aitkin.