Treatment Costs Often Not Discussed Among Patients, Providers

Oftentimes out-of-pockets costs affect medication adherence, and researchers suggests patients and health care professionals (HCP) discuss costs in the treatment decision-making process. However, according to a new study, presented at 2018 ACR/ARHP Annual Meeting, researchers found that patients and HCPs do not always discuss cost unless it is addressed by patients who perceived it as “very important.” 

“Patients often have to pay for prescription medications out-of-pocket and cost-related nonadherence is a recognized problem,” said researcher K. Julia Kaal, MSc, of the University of British Columbia, and colleagues. “The treatment of rheumatoid arthritis is associated with high out-of-pocket cost. Research has shown that while patients may have a desire to discuss medication costs with [HCPs] these discussions often do not take place.”

To examine the frequency with which out-of-pocket medication costs are discussed and to examine predictors of these discussions between rheumatologists and patients with rheumatoid arthritis (RA), the research team conducted a cross-sectional online survey that was distributed to patients with RA and rheumatologists. The survey participants were asked to rate the importance of discussing out-of-pocket treatment costs, as well as how often medication costs are discussed between physician and patients. 

The researchers identified 78 patients and 64 rheumatologists for the study. According to the findings, there were no differences in the perceived importance of discussing medication costs between patients and physicians with over 65% of physicians and patients rating it as “quite or very important.” Additionally, 22% of patient respondents reported never talking about medication cost when asked whether they discuss costs during health care visits. The researchers found no significant differences across responses to having talked about medication cost by income, education, age, or province.

“In multivariable logistic regression models, the odds of discussing cost among patients who perceived discussing cost with their HCP as ‘very important’ were 4.5 (P = .043) higher than patients who perceived discussing cost as ‘neither important nor unimportant’ or ‘not important’.” 

The researchers noted that there were no other characteristics found that were significant predictors of discussing medication cost. Further, they said that no patient characteristics were statistically significant predictors of perceived important of discussing cost. 

“Out-of-pocket costs have been shown to affect medication adherence; consequently patients and HCPs should discuss costs in the treatment decision making process,” said Ms Kaal and colleagues. “Our findings suggest this does not always happen.”

“In the absence of any clear predictors of the perceived importance of discussing costs to patients, treatment costs and ability to pay should be discussed routinely, as an important component of shared decision making.”—Julie Gould