Compliance (medicine) - Societal Impact

Societal Impact

A WHO study estimates that only 50% of patients suffering from chronic diseases in developed countries follow treatment recommendations. The figures are even lower in respect to adherence rates for preventative therapies, and can be as low as 28% in developed countries. citation neededThis may affect patient health, and affect the wider society when it causes complications from chronic diseases, formation of resistant infections, or untreated psychiatric illness.

In the UK, the government spends £757 million per year on medications alone in mental health care. 4,000 people per year, mostly from young age groups, take their lives; with some studies suggesting the figure is nearer to 6,000, and that suicide is under-reported. 90% of suicides are mentally ill patients. Overall, 15% of people with depression, schizophrenia or alcohol problems will commit suicide, mostly through dispair. If patient understanding and adherence can be increased by just 30%, the outcome would be a 20% reduction in suicides. This represents a saving of 800 lives per year from some of the most vulnerable sectors of society.

The total cost to the UK Government in medications is a hefty £12 billion, two thirds of which is being wasted through poor adherence. The cost in extra visits through crushing heart failure, exacerbation of emphysema, stroke, heart attack, confusion, falling, ambulance calls, hospital admissions, unnecessary excess medications through the patient not taking their first medication correctly, additional outpatient visits runs to many billions of pounds each year.

Compliance rates during closely monitored studies are usually far higher than in later real-world situations. For example, one study reported a 97% compliance rate at the beginning of treatment with statins, but only about 50% of patients were still compliant after six months.

The experience of Patient Connect Service Limited in the UK is that medicines prescribed for preventative purposes are especially likely not to be taken as prescribed; perhaps because people do not feel immediately threatened or, in the case of symptomless conditions such as raised cholesterol levels (hypercholesterolaemia) and raised blood pressure (systemic hypertension), feel no obvious benefits at the time of taking the medicines. In essence, diseases such as hypertension and hypercholesterolaemia are silent diseases. As a result, patients are not motivated and do not understand why they need to take medicines for a silent disease.

The UK figures make for salutary reading:

• up to 90% of diabetes patients do not take their medication well enough to benefit from that medication.
• 33-50% of some cancer patients take less of their anti-cancer medicine than required.
• only 75% of coronary heart disease (CHD) patients take sufficient medicine for it to be effective.
• Up to 75% of hypertensive patients do not adhere to their medicine.
• 41-59% of mentally ill patients take their medication infrequently or not at all.
• 33% of patients with schizophrenia don’t take their medicine at all, and 33% are poorly adherent.
• Less than 27% depressed patients adhere to their medication.

In the UK, the societal impact of such high levels of non-compliance is significant:

• 110,000 people per year die prematurely from coronary heart disease that is largely preventable. Death rates are three times higher in manual workers than among managers.
• If CHD patients adhered to their medication, each year 40,000 – 50,000 fewer people would have a stroke and 25,000 would not have a heart attack.
• 25% of cancer patients have to cut back on food shopping to cover the extra costs of cancer.
• 70% of patients with advanced cancer suffer with pain, very often in conjunction with other symptoms such as nausea, vomiting, loss of appetite, anxiety, depression, sleeplessness, and confusion, amongst other symptoms.
• Cancer has one of the highest tolls of all disease areas on quality of life, families, happiness and life itself.
• 1,400 people die from asthma attacks each year, 90% of which are avoidable.

The financial cost to the UK National Health Service (NHS), and thus to society, is also high:

• In respect to strokes, the cost to the UK in terms of rehabilitation and loss of earnings £7billion per year on strokes.
• CHD costs the NHS in excess of £2billion on medicines; 50% of which is wasted through poor understanding and poor adherence.
• Depression costs the UK government a staggering £9billion each year, mostly through people having to take time off work.
• The UK government spends £3.6billion on cancer each year. Adherence through better understanding needs to be improved in a third or more of patients to help improve and save lives, and to avoid waste.
• Asthma has been estimated to cost the NHS an amount approaching £1 billion per year. Yet, an estimated 75% of hospital admissions for asthma are avoidable. Economic studies consistently show that the costs incurred with poorly controlled asthma are higher than those for a well-controlled patient with the same severity of disease. For severe asthma, it has been estimated that the savings produced by optimal control would be around 45% of the total medical costs.