title: Cost-related medication underuse: prevalence among hospitalized managed care patients.
abstract: BACKGROUND
  The affordability of prescription medications continues to be a major public health issue in the United States. Estimates of cost-related medication underuse come largely from surveys of ambulatory patients. Hospitalized patients may be vulnerable to cost-related underuse and its consequences, but have been subject to little investigation.
  
  
  OBJECTIVE
  To determine impact of medication costs in a cohort of hospitalized managed care beneficiaries.
  
  
  METHODS
  We surveyed consecutive patients admitted to medical services at an academic medical center. Questions about cost-related underuse were based on validated measures; predictors were assessed with multivariable models. Participants were asked about strategies to improve medication affordability, and were contacted after discharge to determine if they had filled newly prescribed medications.
  
  
  RESULTS
  One-hundred thirty (41%) of 316 potentially eligible patients participated; 93 (75%) of these completed postdischarge surveys. Thirty patients (23%) reported cost-related underuse in the year prior to admission. In adjusted analyses, patients of black race were 3.39 times (95% confidence interval [CI], 1.05 to 11.02) more likely to report cost-related underuse than non-Hispanic white patients. Virtually all respondents (n = 123; 95%) endorsed at least 1 strategy to make medications more affordable. Few (16%) patients, prescribed medications at discharge, knew how much they would pay at the pharmacy. Almost none had spoken to their inpatient (4%) or outpatient (2%) providers about the cost of newly prescribed drugs.
  
  
  CONCLUSIONS
  Cost-related underuse is common among hospitalized patients. Individuals of black race appear to be particularly at risk. Strategies should be developed to address this issue around the time of hospital discharge.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA. nchoudhry@partners.org
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Uzaib Y
authors.initials: UY
authors.lastname: Saya
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.forename: Jeffrey O
authors.initials: JO
authors.lastname: Greenberg
authors.forename: Caroline
authors.initials: C
authors.lastname: Melia
authors.forename: Amy
authors.initials: A
authors.lastname: Bilodeau
authors.forename: Emily K
authors.initials: EK
authors.lastname: Kadehjian
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Dolan
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Dudley
authors.forename: Allen
authors.initials: A
authors.lastname: Kachalia
mesh_terms: D000328:Adult; D016527:Drug Costs; D017723:Drug Utilization Review; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence