The impact of non-adherence to therapies for vertigo: Higher costs and poorer outcomes

Key Messages

• Medication non-adherence is widespread and annual cost estimates for developed countries total $290 billion in the US and €1.25 billion in Europe.
• Vertigo is a significant burden for patients and providers alike, particularly because patients tend to seek emergency care when symptoms are acute.
• Small improvements in adherence could significantly improve symptom management and reduce costs.

Treatment adherence can significantly improve outcomes

Vertigo and dizziness are extremely widespread symptoms and can become debilitating if not managed properly. ¹ Symptoms can be severely disabling and significantly increase healthcare utilization.² Medication and other therapies widely used for vertigo and can improve outcomes.^{3, 4} Adherence is key for effectiveness, but it is often poor, exacerbating the disease burden in low- and middle-income countries.⁷

Non-adherence is a global issue increasing costs and negatively affecting outcomes

Non-adherence to prescribed therapies, particularly medication, is associated with negative outcomes, reduced quality of life, and wasted healthcare resources.³ The magnitude of costs associated with non-adherence is staggering: Annual cost estimates for the US and Europe total $290billion and €1.25billion, respectively.⁸ In the UK, non-adherence is believed to cost the NHS more than £500 million per year.⁹ Studies in the US indicate that medication non-adherence is responsible for 10% of hospitalizations and 23% of nursing home admissions in older adults,¹⁰ with the typical non-adherent patient requiring three extra medical visits per year and generating an additional $2,000 in treatment costs per annum.⁸ While specific information on non-adherence in developing countries is not available, because secondary prevention medicines are often difficult to access and afford in many of these countries, non-adherence trends and the concomitant healthcare utilization and increased costs can reasonably be expected to yield poorer outcomes.²

Improving adherence to vertigo therapies could reduce patient and healthcare provider burdens

Vertigo treatment is a significant burden for patients and healthcare providers. While generally treated at the primary care level, individuals with acute vertigo may present at all levels of the healthcare system, including emergency services, leading to multiple and potentially unnecessary procedures, repeated specialist visits, and even hospitalizations. Studies in developed countries demonstrate that patients with vertigo typically present for 9.6 visits to their primary care provider; 7.2 visits for specialist care; and 2.4 presentations occurring at the emergency department leading to hospital stays of 6.8 days annually. Imaging procedures such as magnetic resonance imaging or computed tomography scans may be performed for as many as 82% of patients.² In a UK-based study, total direct costs for Meniere’s disease, just one of the underlying conditions causing vertigo, were estimated to be greater than $900 million.¹¹ While adherence information for the vertigo patient population is limited, even small improvements in adherence leading to improved symptom management could reasonably be expected to have a significant effect in reducing both the burden for patients and unnecessary healthcare utilization.²

Addressing the indirect costs of vertigo is a significant opportunity to improve outcomes

The indirect costs of vertigo are significant. From a monetary perspective, symptoms are associated with a loss of up to 69 working days in a 12-month period. Approximately 70% of patients must reduce their workload, 4.6% change jobs, and 5.7% quit working. From a non-monetary perspective, up to 18% of patients report that they avoid leaving the house, a significant number of patients report a reduced quality of life, and fear of increased risk of falls.² These estimates do not account for the impact on family, which may be severe if symptoms are disabling to the breadwinner, nor the economic implications for society. Simple treatment interventions that can alleviate vertigo symptoms and avoid complications therefore have significant potential to reduce indirect costs and improve quality of life for both patients, family members, and society.

Improving trends in vertigo requires a comprehensive understanding of adherence drivers

The magnitude of the burden presented by vertigo patients coupled with the negative effects of non-adherence demand a solution. Factors influencing adherence are numerous and complex. Initiatives to improve adherence must be rooted in a comprehensive understanding of drivers of adherence problems and how they might be effectively addressed. Physicians play a key role in improving patients’ adherence,⁴ both to medications and to lifestyle recommendations. Future articles will examine behavioral drivers in detail and provide simple tools and strategies for healthcare professionals to help them “nudge” patients toward better adherence.

Just as physicians must make proper clinical diagnoses and treatment decisions, they can also have significant influence on outcomes by making the right behavioral diagnoses and treatment choices. This will be the focus of future articles.

References:
1. Eva Kovacs et al. (2019) “Economic burden of vertigo: A systematic review,” Health Economics Review, (9):1, p. 37. https://doi:10.1186/s13561-019-0258-2
2. Eva Grill et al. (2016), “Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: Systematic review,” Journal of Neurology, (263):1 Supp., pp. 36–44. https://doi:10.1007/s00415-015-7913-2
3. Louisa Murdin, Kiran Hussain, & Anne GM Schilder (2016). “Betahistine for symptoms of vertigo,” Cochrane Database of Systematic Reviews, (6), Article cd010696. https://doi:10.10021/14651858.CD010696.pub2
4. L. Timmerman et al. (2016). “Prevalence and determinants of medication non‐adherence in chronic pain patients: a systematic review,” ACTA Anesthesiologica Scandanvica, (60):4, pp. 416–431. https://doi.10.1111/aas.12697
5. World Health Organization (2011). Global Health and Aging, p. 4. https://www.who.int/ageing/publications/global_health.pdf
6. Safia Awan et al. (2017). “Pattern of neurological diseases in adult outpatient neurology clinics in tertiary care hospital,” BMC Research Notes, (10):1, p. 545. https://doi:10.1186/s13104-017-2873-5
7. Rachelle Louise Cutler et al. (2018). “Economic impact of medication non-adherence by disease groups: A systematic review,” BMJ Open Journals, (8):1, Article e016982. http://doi:10.1136/bmjopen-2017-016982
8. Lynne Taylor (2013). “Drug non-adherence ‘costing NHS £500M+ a year,’” PharmaTimes, 19 February, 2013, https://www.pharmatimes.com/news/drug_non-adherence_costing_nhs_500m_a_year_1004468
9. Shalini Lynch (2019). “Adherence to drug treatment,” MSD Manual Consumer Version, August 2019. https://www.msdmanuals.com/home/drugs/factors-affecting-response-to-drugs/adherence-to-drug-treatment
10. Jessica Tyrrell et al. (2016). “The cost of Meniere’s disease,” Ear and Hearing, (37):3, pp. 202–209. https://doi:10.1097/aud.0000000000000264
11. Michael Weiser et al. (1998). “Homeopathic vs conventional treatment of vertigo,” JAMA Archives of Otolaryngology–Head & Neck Surgery, (124):8, p. 879. https://doi:10.1001/archotol.124.8.879