Multiple chronic diseases linked to higher out-of-pocket medication costs

Patients’ out-of-pocket expenditures (OOPE) on medications rise dramatically with the addition of each coexisting chronic condition, according to a systematic review published online Feb. 6 in BMJ Global Health.

After studying 14 articles from five different countries, the researchers found annual OOPE on medicines increased by 2.7 times for patients with one non-communicable disease (NCD) versus zero. Patients with two chronic diseases saw a 5.2-fold increase in OOPE on medicines compared to those with zero, while individuals with three or more comorbidities experienced a 10.1-fold increase.

Diabetes, hypertension, stroke, arthritis and respiratory disease were the most common diseases studied.

“Despite multimorbidity being the norm rather than the exception for the older population, current clinical practice remains focused on single chronic disease in isolation,” senior study author John Tayu Lee, PhD, from the Nossal Institute for Global Health at the University of Melbourne, said in a press release. “Our findings suggest that we need to think more carefully about how to improve the cost-effectiveness of treating patients with multiple chronic diseases.”

Mean household disposable income spent on medications ranged from 0.36 percent for zero chronic diseases to 2.63 percent for those with at least three chronic conditions.

The researchers found elderly and low-income groups were most susceptible to higher OOPE, and certain combinations of comorbidities were costlier than others with the same number of diseases. For instance, acute coronary syndrome—both by itself and in conjunction with other conditions—required higher medication expenditures than diabetes in one study.

“This is likely due to certain NCDs requiring more medicines or more expensive medicines than others,” the authors wrote. “A greater number of multimorbidities were also associated with higher OOPE on medicines as a proportion of total healthcare expenditures by patients, which may have implications that multimorbid patients with higher OOPE on medicines had to allocate less resources to other medical services.”

On the other hand, the researchers said some patients who experience high drug costs simply quit refilling their prescriptions, which could lead to adverse outcomes and increased healthcare costs later if they require hospitalization.

A limitation of the review is it contained several studies that only reported the number of chronic conditions its participants had—not which exact conditions. The researchers suggested future studies look at which specific diseases are associated with the highest out-of-pocket medication costs.

In the meantime, they said policy protections could prevent OOPE on medicines from becoming crippling for chronically ill older patients and those with a lower socioeconomic class. In addition, they called for improved clinical prescription guidelines to eliminate “unessential” pharmaceuticals. This could reduce the financial burden on patients and improve adherence for essential medications by giving them simpler treatment regimens.