Medication characteristics beyond cost alone influence decisions to underuse pharmacotherapy in response to financial pressures

J Clin Epidemiol. 2006 Jul;59(7):739-46. doi: 10.1016/j.jclinepi.2005.11.023.


Background and 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).

Materials and 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.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Analgesics / administration & dosage
  • Analgesics / economics
  • Choice Behavior*
  • Chronic Disease
  • Female
  • Histamine H1 Antagonists / administration & dosage
  • Histamine H1 Antagonists / economics
  • Humans
  • Male
  • Middle Aged
  • Prescription Fees*
  • Regression Analysis
  • Self Medication / psychology*
  • Socioeconomic Factors
  • United States


  • Analgesics
  • Histamine H1 Antagonists