The World Health Organization (WHO) defines patience adherence as the ‘the extent to which a person’s behavior – taking medication, following a diet, and/or executing lifestyle changes – corresponds with the agreed upon recommendations from a health care provider’. Good adherence is key to achieve favorable treatment outcomes. However, the deprived adherence to medications is a major problem observed across different medical specialties. It also has been recognized as a global public health problem, especially when it comes to chronic disease management, which ultimately affects the overall treatment plan and its outcomes. According to several studies, around 50% to 60% of people are likely to skip medications, treatment protocols, and follow-up appointments, which is responsible for the huge number of unnecessary deaths in the United States and European countries. The US pharma industry loses approximately $188 billion each year due to these unnecessary deaths.
Several researches have been carried out on nonadherence and the key findings of these are surprising. The nonadherence to medication is driven by various factors – how often to take the medication, dosage patterns, route of administration, drug cost, etc. According to a large-scale pilot study conducted in 2011, around 600,000 patients were examined to determine the core cause of nonadherence. Two-thirds of the nonadherence was due to distraction and procrastination. Among these, around 39% patients simply forgot to take their medications, 10% delayed the medication refill, and the remaining patients did not renew their prescriptions.
The following pie chart depicts the reasons for nonadherence:
Each year, nonadherence causes around $300 billion wasteful expenditure for the healthcare systems, which is enough to cover the healthcare costs of around 30 million Americans. According to a research, 10% improvement on adherence alone can reduce the healthcare costs by 29%, and approximately 1% improvement would save about $50 in healthcare spending each year. In addition, healthcare costs from $4,000 to $8,000 can be saved each year if the patients with chronic conditions such as diabetes and hypertension adhere to their medication as per the prescriptions.
Considering the huge impact of nonadherence, the pharmaceutical industry is motivated commercially and clinically to find ways to address this issue. Many pharmaceutical and medical device manufacturers have come up with innovative solutions. mHealth has the biggest contribution in providing solutions for nonadherence. Currently, there are more than 20,000 mobile applications or health apps, and most deal with medication adherence. Care4Today™ by Johnson and Johnson, forCare app by Novartis, ChemoDiary by Merck & Co., My Pillbox by mypillbox.org, etc. are a few smartphone applications that help to adhere to the medication schedule and dosage patterns. These applications also remind to refill the prescriptions via SMS, app notifications, and e-mails.
In addition to these smartphone applications, many medical device companies such as Pillsy Inc., AdhereTech, and Proteus Digital Health have developed smart pills and bottles which are sensor-based or weight-based devices. These bottles/devices record the dosage based on the number of pills removed from the bottle. Smart pill is a revolutionary device developed by Proteus Digital Health, which is an ingestible sensor that records the medication adherence based on whether the patient swallows the pill or not. The pills send a signal to the patch worn by patients to record the activity. The sensor then dissolves when it hits the gastrointestinal track.
Apart from technologically driven solutions, many pharmaceutical companies have improved the drug packaging to ensure the adherence. For example, solid-dosage compliance and drug reminder packaging help the patients to know which tablet is already taken. Many pharmaceutical companies have improved packaging to target the geriatric population with color coding for different days or weeks to ensure the adherence.
Furthermore, the different stakeholders such as pharmaceutical companies, tech service providers, and other service providers are collaborating with each other to develop more innovative and user-friendly solutions to improve adherence. For example,
– The Japanese company, Otsuka Pharmaceutical, collaborated with Proteus Digital Health to work on ‘smart pills’. The company is currently seeking approval from the US Food and Drug Administration
– Similarly, Novartis is working with Qualcomm to develop chip-based smart inhalers which record the usage activity to improve adherence in patients with chronic respiratory conditions
– Companies such as Pfizer, Merck and Co., and Sanofi are conducting campaigns to spread the awareness and importance of adherence among patients across the globe. Merck developed a game called ‘Type 2 Travelers Project’ to engage patient’s adherence through an improvisation activity. The game helps patients to follow treatment schedules and to manage other health aspects.
Nonadherence to medication is one of the biggest problems faced by the pharmaceutical industry. It causes unnecessary healthcare expenditure. Thus, pharmaceutical companies are focusing on ways to reduce the healthcare costs and ensure maximum resource utilization by improving adherence. Nonadherence and its increasing impact on the patient outcomes has motivated pharmaceutical companies to invest in adherence awareness programs and activities, and develop innovative solutions to deliver a win-win situation for patients, healthcare practitioners, and themselves. Pharma companies can increase revenues, improvise product differentiation, and gain higher market position by continuing to focus on adherence. The more the adherence, the more positive results for the patients and the pharma companies delivering the medication.