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Cost-Cutting on Drugs Has Health Cost

People suffer more when they curtail prescription use

FRIDAY, June 25, 2004 (HealthDayNews) -- Middle-aged and elderly Americans who cut back on prescription drugs for chronic illnesses because of the expense do so at the expense of their health.

New research shows, for the first time, that people with preexisting chronic medical conditions who curtailed their prescription medications because of cost were 76 percent more likely to then suffer a significant decline in their overall health and 50 percent more likely to have a nonfatal heart attack, stroke or chest pain episode than those who did not cut back.

The findings are published in the July issue of the American Public Health Association's journal Medical Care.

"The study is consistent with a large body of literature that demonstrates the health consequences and the financial barriers to necessary drugs, and I think we can really hope there will be an impact because there's so much we can do," said Dr. Arlene S. Bierman, the author of an accompanying editorial in the journal, who was previously a research physician at the U.S. Agency for Healthcare Research and Quality in Rockville, Md.

Both the use and the cost of prescription drugs have been rising rapidly in the United States. Annual aggregate expenditures increased to $162 billion in 2002, up from $51 billion in 1993, according to Bierman's editorial.

For many people, these rising costs are eroding the health benefits of new and more effective drugs. But there has been little data to show how prohibitively high costs translated into health outcomes.

This study, done by researchers from the University of Michigan and the VA Ann Arbor Healthcare System and funded by the National Institute on Aging, is the first to demonstrate harm to health over time -- and over a relatively short period of time, too, just two to three years.

The researchers focused on about 8,000 older adults who were regularly taking prescription medications for heart disease, diabetes, high blood pressure or stroke. This put them at a higher risk for later heart-related illness or crisis, problems that can often be prevented with medications.

At the end of the three-year study, 10 percent of participants said they had cut back on drugs because they were too expensive. Of these, 11.9 percent suffered chest pain, compared to 8.2 percent of those who hadn't cut back. Also, 7.8 percent of those who had reined in drug use suffered a nonfatal heart attack by the end of the study, compared to 5.3 percent of those who had not reduced.

Participants 72 years and older who suffered from depression at the beginning of the study and who curbed their medication were 16 percent more likely to experience a worsening of their depression.

Overall, 32.1 percent of those who reported that they were in good health or better at the beginning of the study, but had curtailed their drug use, characterized their health as fair or poor at the study's end. Only 21.2 percent of those who did not cut back said they had experienced a decline.

The declines were not across the board. People who cut back on arthritis medication did not experience worsening pain or physical limitations, possibly because they substituted over-the-counter medications. Also, diabetics did not have higher rates of new proteinuria or kidney disease, but these may need more time to show up.

People who cut back tended disproportionately to be uninsured or have health insurance that didn't cover prescription drugs. This finding may help explain why poorer people tend to have worse health outcomes.

The addition last month of prescription drug benefits for Medicare patients may help a little, but it will take a while to see how much, the authors stated.

The results of the new research present a good argument for stratifying risk, meaning providing extra coverage for people who have preexisting chronic conditions, said Dr. Michele Heisler, lead author of the study, a research scientist at the Veterans Administration, and a lecturer at the University of Michigan Medical School.

"This is a population that has a huge clinical benefit from having coverage of their prescriptions," she said. "If we cover their pharmacy benefits, we may find that we're actually saving a huge amount of money because we're preventing them from having heart attacks and disability and other problems downstream."

Dialogue between physicians and patients may also help alleviate the problem, she added.

"It's really important that patients not be embarrassed. Medication costs are overwhelming," Heisler said. "They should bring it up with their doctors, because doctors are not very proactive and clinicians need to be aware that a really significant percent of people have this problem."

More information

Medicare has more on the prescription drug benefit.

SOURCES: Michele Heisler, M.D., research scientist, Veterans Administration and lecturer in general medicine, University of Michigan Medical School, Ann Arbor; Arlene S. Bierman, M.D., Ontario Women's Health Council Chair Women's Health, University of Toronto and St. Michael's Hospital, Toronto; July 2004 Medical Care
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