A study reveals that financial hardship still affects one in six asthma patients, increasing the risk of attacks and emergency visits.
Although the past decade has seen a decline in the number of individuals with asthma reporting that cost prevents them from taking their prescribed medications, financial hardship continues to be a barrier for one in six patients, according to research published in the respiratory medicine journal Thorax.
The study highlights that non-adherence to prescribed treatments nearly doubles the risk of asthma attacks and increases the likelihood of emergency department visits by over 60% (1✔ ✔Trusted Source
Cost-related non-adherence to medications among adults with asthma in the USA, 2011-2022
).
The findings reinforce the importance of healthcare policy in promoting equitable access to drug treatment, concludes a linked editorial.
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Challenges in Treatment Adherence
In 2021, the Centers for Disease Control and Prevention estimated that around 20 million adults (8%) had asthma in the USA. Although the condition can be well controlled with medication, the prevalence of non-adherence to treatment is high, note the researchers.
To find out what factors might be driving this among patients with asthma, the researchers drew on the survey responses of 30,793 adults with the condition (about 8% or 19.38 million of the US population), to the nationally representative annual National Health Interview Survey (NHIS) from 2011 to 2022.
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Key Survey Questions on Medication Use
Survey respondents were asked if, over the past 12 months: they had skipped medication doses; or taken fewer doses; or delayed repeating their prescriptions to save money. Answering yes to any of these questions was defined as not sticking to their treatment regimen as prescribed because of its cost.
Respondents were also asked if, over the past 12 months: they had had an episode of asthma/asthma attack; or had had to visit emergency care or an urgent care center because of their asthma.
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Financial Barriers to Asthma Medication Adherence
Overall, 18% of survey respondents with asthma said they couldn’t afford to take their meds as prescribed, equivalent to just short of 3 million of the US population with the condition.
To save money, 12% (1.95 million equivalent) of respondents said they skipped medication doses; 12.5% (2.06 million equivalent) said they took fewer doses; and 15% (2.54 million equivalent) said they delayed repeating their prescription.
The proportion citing cost as a reason for not sticking to their treatment regimen fell significantly during the 12-year period, from 23% in 2011 to 13% in 2022. But that still left the equivalent of 1 in 6 adults with asthma citing financial hardship as the reason for not taking their meds as prescribed in 2022.
Regional and Socioeconomic Influences on Adherence
Those aged 18–60, women, and Black people were more likely to report not taking their meds as prescribed because of the expense. Other influential factors included living in Southern US states, low educational attainment, lack of health insurance, low household income, co-existing conditions, and living alone.
Those citing financial hardship had nearly double the the odds of an asthma attack and a more than 60% heightened risk of visiting emergency care than those for whom cost wasn’t a factor.
Limitations of the Study
This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. The researchers also acknowledge that their study relied on subjective assessment rather than on diagnostic tests and medical records, and they weren’t able to evaluate the potential impact of asthma severity on medicines compliance either.
Impact of Healthcare Policy
They suggest that the falling trend in people citing cost as a reason not to take their meds as prescribed might be due to the introduction of the Patient Protection and Affordable Care Act in 2010, which aimed to improve access to health insurance and services, and the expansion of Medicaid in 2014.
“With fewer barriers to accessing healthcare, including medications, patients may be more willing to fill prescriptions for medications to control their asthma than before,” they suggest.
In a linked editorial, Emily Graul and Dr Christer Janson of, respectively, Emory University School of Medicine, Atlanta, and the Department of Medical Sciences, Uppsala University, Sweden, point out that asthma meds make up around half of the total spend on the condition.
“Therefore, efforts to reduce cost-related medication non-adherence not only lessen the financial burden on the US health system but also support people’s ability to improve their disease symptoms,” they suggest, adding that continued policy and legislation efforts are needed to ensure this happens.
Exclusion of Respiratory Medications from Price Reductions
“The Inflation Reduction Act’s associated Medicare Drug Price Negotiation Program lowered drug costs for several chronic conditions, but so far this has not included drugs for respiratory conditions, including asthma despite their high gross annual spending.
“The results of this study beg the question: should certain asthma medications be part of the next batch of drug negotiations?”
Reference:
- Cost-related non-adherence to medications among adults with asthma in the USA, 2011-2022 – (https://thorax.bmj.com/content/early/2024/11/20/thorax-2024-221778)
Source-Eurekalert
