If doctors and patients used prescription drugs more wisely, they could save the U.S. health care system at least $213 billion a year, by reducing medication overuse, underuse and other flaws in care that cause complications and longer, more-expensive treatments, researchers conclude.
The new findings by the IMS Institute for Healthcare Informatics improve on numerous prior efforts to quantify the dollars wasted on health care.
Numerous experts previously have estimated that tens of billions, perhaps hundreds of billions of dollars, could be better used each year to improve patient care and outcomes and to slow down spending by government health programs, insurers and consumers.
The institute, part of data analysis and consulting firm IMS Health, used its proprietary data on prescriptions written by doctors — many of which patients never fill — plus other information to produce a current, more reliable estimate of avoidable costs solely related to medication use.
IMS arrived at the $213 billion figure based on six categories in which doctors, patients or both could be making better use of medication, from getting a prompt diagnosis when new symptoms arise to taking medicines as directed by the doctor. Across the six categories, the researchers generally focused on spending on a handful of very common or very expensive diseases — from high cholesterol and blood pressure to HIV and diabetes — for which costs of care and complications are well documented.
"There's even larger avoidable costs if we were to look at all disease areas" where patients aren't getting optimal care, Murray Aitken, the institute's executive director, told The Associated Press in an exclusive interview. "There's a big opportunity for improvement."
The $213 billion equals nearly 8 percent of the more than $2.7 trillion the U.S. spent on health care last year. Those billions could pay for the health care of more than 24 million Americans currently uninsured, according to IMS.
And Aitken said more-appropriate use of medication — taking it exactly as prescribed, not taking antibiotics for viral illnesses, preventing medication errors and the like — could prevent 6 million hospitalizations, 4 million trips to the emergency room and 78 million visits to doctors and other outpatient care providers each year.
"Those are staggering numbers," Aitken said.
The report, titled "Avoidable Costs in Healthcare," found the biggest area of waste is patients not taking medicines prescribed by their doctor, either at all or as directed. IMS estimates the cost of such "non-adherence" at about $105 billion a year.
Reasons for the longstanding problem include patients fearing drug side effects, not understanding complications that can occur without treatment, having mental health issues and not being able to afford their medicines. Price has become less of a factor, though, as there are now relatively inexpensive generic versions of drugs for most diseases.
"I think there's really good, solid evidence that if you adhere to medications, that keeps you out of the hospital," said M. Christopher Roebuck, president of health policy consultants Rx Economics LLC.
Roebuck, who was not involved in the study, said it's well done. But he said the estimates of potential savings are "quite conservative" for medication non-adherence and treatment delays.
Those delays are blamed for racking up about $39 billion a year in avoidable care costs — due to patients putting off doctor visits and not getting medications they're prescribed, or doctors not promptly starting treatments proven to prevent expensive complications.
"We've got a lot of people without insurance who are not routinely going to the doctor, and even some with insurance aren't," Aitken said.
Other areas of waste noted in the report include:
— Prescribing antibiotics inappropriately, as for patients with the flu or another viral infection, costing about $35 billion annually. This can contribute to bacteria becoming resistant to antibiotics, resulting in more expensive treatment and even hospitalization with a future infection.
— Medication errors, costing about $20 billion annually. Those include sloppy handwriting leading to the wrong drug or dose being dispensed and doctors not checking to see that the patient is getting better, meaning they've been getting the right medicine. Those errors are on the decline due to more doctors using electronic prescriptions and other changes.
— Not using generic drugs when they are available, costing about $12 billion annually. That's a decreasing problem, as strategies of health plans and pharmacies encourage patients to choose generics by setting copayments for brand-name drugs a few times higher than for the generics. Without insurance, generics can cost 90 percent less than brand-name drugs. Today, when a generic is available, it's dispensed about 95 percent of the time.
— Multiple medication confusion, costing about $1.3 billion annually. For elderly patients taking five or more medicines, it's easy to mix up which pills should be taken when, and for those who are frail, those mistakes can cause serious harm. That problem likely will grow significantly with our aging population.
The report will be shared with government, medical and policy groups and other stakeholders in the health system, Aitken said.
The institute, whose clients include major drugmakers, noted that its report was prepared without funding from government or the pharmaceutical industry.
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