Bending the Curve through Adherence

  • by: |
  • 08/23/2012

How about healthcare evolution through personal responsibility?

Increased adherence to non-insulin hypoglycemic drugs in diabetes patients can reduce hospitalizations or emergency room visits by nearly 13%, according to a large observational study conducted by researchers at Harvard and Express Scripts and published in the August issue of Health Affairs.

The researchers estimate that improved adherence to diabetes drugs could save nearly $5 billion annually across the U.S. health care system.

The study analyzes medical and pharmacy claims from 2006 through 2008 for approximately 136,000 patients with diabetes who were continuously enrolled in a private health plan or covered through a self-insured employer during that time.

In 2006, approximately 40% of patients in the study were non-adherent to their diabetes medication. Of that group, 32% (or 17,279) became adherent in 2007. After adjusting for underlying differences in co-morbidities and socioeconomic factors, the researchers found that “increased adherence was associated with nearly 13% lower odds of being hospitalized or visiting an emergency room.”

Conversely, “losing adherence was associated with nearly 15% higher odds of being hospitalized or having an emergency department visit in the following year.” In addition, “we found that those who remained adherent had the lowest rates of hospitalizations or emergency department visits” across all groups, at 27%.

Using census data, the authors found that “for patients from zip codes with high percentages of minority populations and for those from poor areas, the benefits of increased adherence were more substantial than they were for patients with zip codes with smaller minority populations or higher average incomes.”

The researchers extrapolated their findings to national medical data to estimate the potential financial benefits of improved adherence. They project that approximately 700,000 emergency room visits and 341,000 hospitalizations could be averted annually if all non-adherent patients with diabetes became adherent.

Quantifying the dollar savings that could result, the researchers estimated that the U.S. could save $3.95 billion in hospitalizations and $735 million in emergency room visits each year, for a total savings of $4.68 billion annually across the health care system.

In addition, 1.6 million Medicare patients lose their adherence in any given year, the researchers reported. And “preventing those losses of adherence would yield an additional $1.71 billion in savings per year to the Medicare program, leading to a potential total benefit of $3.93 billion to Medicare alone.”


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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