Background/Purpose:

Patients often have to pay for prescription medications out-of-pocket and cost-related nonadherence is a recognized problem. 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 health care professionals (HCPs) these discussions often do not take place. The objective of this study was 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) in Canada.

Methods:

A cross-sectional online survey was distributed to patients with RA and rheumatologists in Canada. Participant characteristics and medication status were assessed and participants were asked to rate the importance of discussing out-of-pocket medication costs, as well as how often medication costs are discussed between physician and patients. Stepwise, multivariable logistic regression was used to explore the predictors of (1) patients discussing costs with their rheumatologist and, (2) perceived importance of discussing medication cost for patients. Potential predictors included age, sex, income, education, use of biologics, and attitude to shared decision making.

Results:

The sample contained 78 patients and 64 rheumatologists. 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. When asked whether they discuss medication cost during health care encounters, 22% of patients reported never talking about medication cost, whereas no physicians reported never discussing costs with their patients. Among patients who reported never talking about medication cost with their physician, 65% (n= 17) were currently taking and 6% (n=1) had taken a biologic agent in the past. There were 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 = 0.043) higher than patients who perceived discussing cost as ‘neither important nor unimportant’ or ‘not important’. No other characteristics were found to be significant predictors of discussing medication cost. No patient characteristics were statistically significant predictors of perceived importance of discussing cost.

Conclusion:

Out-of-pocket costs have been shown to affect medication adherence; consequently patients and HCPs should discuss costs in the treatment decision making process. Our findings suggest this does not always happen. Furthermore, medication cost was more likely to be discussed by patients who perceived it as ‘very important.’ This finding suggests that the onus to initiate discussions about cost is currently on patients, not HCPs). 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.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-physician-communication-about-medication-costs-in-rheumatoid-arthritis/