Relationship between Cost of Care and Medication Adherence among Hypertensive Patients Attending a Tertiary Health Facility in Ekiti State, Nigeria

Abstract

Background: The economic burden of care is a barrier to effective treatment of hypertension as affordability of drugs may affect medication adherence. This study assessed the cost of care and level of medication adherence among patients with hypertension attending a tertiary hospital in Ekiti State, Nigeria.
Methods: This was a descriptive cross-sectional study that used a systematic sampling technique to select eligible patients. Data was collected with an interviewer-administered questionnaire. Medication adherence was assessed with eight-item Morisky Medication Adherence Scale (MMAS-8). Data entry and analysis were done using IBM SPSS version 22.0. p-value < 0.05 was considered statistically significant.
Results: The median age (Interquartile Range) of respondents was 55.0 (20.3) years with male to female ratio of 1:1.2. The mean monthly cost of care of hypertension was ₦15,964.76 (US$44.35). Only 47 (34.1%) respondents were adherent (MMAS score of ≥8) to their medications. Medication adherence was inversely associated with total cost of admissions (p=0.024) and cost of admission drugs/consumables (p=0.028). Male gender (AOR=12.561;95%CI=2.248–70.189), middle-age (45-64years) (AOR=11.577;95%CI=1.015- 131.998), being unmarried (AOR=0.006;95%CI=0.000–0.300), exercising <3days per week (AOR=0.055;95%CI=0.006–0.489), employment in informal and formal occupations (AOR=0.024,0.022; 95%CI=0.001–0.590,0.001–0.591) and living with someone (AOR=0.000;95%CI=0.000–0.086) were significant predictors of medication adherence.
Conclusion: Medication adherence was suboptimal and negatively associated with total cost of admissions and cost of admission drugs/consumables. Attention should therefore be given to developing and implementing measures such as subsidy on drugs and increasing coverage of health insurance that would limit the impact of these costs on the patients.

Keywords: Cost of care; Medication adherence; Hypertension; Ekiti