title: Medication characteristics beyond cost alone influence decisions to underuse pharmacotherapy in response to financial pressures.
abstract: OBJECTIVE
  Little is known about how patients facing medication cost pressures make choices about whether to underuse one or more of their prescription drugs. We calculated the probability that older adults would underuse prescription medications for common chronic illnesses because of cost concerns. We also identified differences in cost-related underuse between symptom-relief medications (e.g., analgesics) and primarily "preventive" medications (e.g., antihypertensives).
  
  
  METHODS
  Older chronically ill patients using both symptom-relief and preventive medications (N = 2,008) were identified as part of a nationwide survey in the United States and reported information about their cost-related underuse of 16 medication types. We used regression models to estimate the probability of underuse for each medication type, assuming average out-of-pocket costs, no prescription coverage, and the sociodemographic characteristics of a typical American aged 50+.
  
  
  RESULTS
  23% of respondents reported forgoing medication in the prior year due to cost. The likelihood of cost-related underuse was higher for symptom-relief medications (27%) than for primarily preventive medications (20%, P < .001). Among the subset of patients who cut back on adherence due to cost, the likelihood of forgoing symptom-relief medication (69%) was higher than that for preventive drugs (54%, P < .001).
  
  
  CONCLUSIONS
  Medication characteristics beyond cost alone influence decisions to underuse treatment in response to financial pressures.
authors.affiliation: Department of Veterans Affairs Center for Practice Management and Outcomes Research, University of Michigan, Ann Arbor, MI 48113-0170, USA. jpiette@umich.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
mesh_terms: D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000191:economics; D002755:Choice Behavior; D002908:Chronic Disease; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011306:Prescription Fees; D012044:Regression Analysis; D012651:Self Medication / Q000523:psychology*; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D000700:Analgesics; D006634:Histamine H1 Antagonists