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Journal of the American Pharmacists Association (JAPhA)Medication Cost-reducing Behaviors in Older Adults with Atrial Fibrillation: The SAGE-AF Study

How are older adults with atrial fibrillation adapting to the rising costs of medication, and what factors influence their cost-reducing behaviors?


In the face of escalating medication prices in the United States, older adults, particularly those with atrial fibrillation (AF), are increasingly engaging in cost-reducing behaviors (CRBs). The SAGE-AF study delves into the patterns of CRB, cost-related medication nonadherence, and the compromises made on basic needs to afford medications. This study also examines the characteristics of participants that are associated with CRB, shedding light on a critical aspect of healthcare management for older adults.

Study Design:

  • Participants: 1,224 older adults (mean age 76, 49% female) with AF and high stroke risk (CHA2DS2VASc ≥ 2).
  • Methods: Prospective cohort study evaluating CRB, cost-related medication nonadherence, and spending less on basic needs using validated measures. Statistical tests were used to examine factors associated with CRB.

Key Findings:

  • CRB Engagement: 69% reported engaging in CRB.
  • Cost-related Nonadherence: 4% reported nonadherence due to costs.
  • Spending Less on Basic Needs: 6% reported compromises on basic needs.
  • Factors Influencing CRB: Cognitive impairment and non-Hispanic white identity were associated with lower CRB engagement, while being married, having a household income of $20,000-$49,999, Medicare insurance, and 4-6 comorbidities were associated with higher CRB engagement.

Conclusion:

  • CRBs are prevalent among older adults with AF, but few reported cost-related medication nonadherence and spending less on basic needs.
  • Targeted support, especially for patients with cognitive impairment, may enhance CRB management and patient assistance programs.

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Did You Know?
Seven out of 10 older adults with atrial fibrillation report engaging in cost-reducing behaviors such as asking for generic medications and purchasing prescriptions online.

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