Simple tool to identify patients at risk of engaging in "medication tradeoffs" after liver transplantation

Researchers at Northwestern University and Emory University propose a simple tool to identify patients who are at risk of engaging in "medication tradeoffs." The study authors address the problem of patients with financial hardship who make the regular choice of meeting basic needs such as buying food rather than paying for medications after receiving a liver transplant.

Researchers conducted detailed, in-person interviews with 105 patients at the two transplant centers who underwent liver transplantation in 2011 and 2012 with the goal of exploring relationships between medication tradeoffs, medication non-adherence, and clinical outcomes. They determined that 17 percent of patients made medication tradeoffs, 10 percent reported an inability to purchase a medication due to cost, and 9 percent made the choice between buying medicine and buying food. Overall, 23 percent reported being non-adherent with medications.

According to Marina Serper, MD, "Individuals frequently have to make choices based on their economic situation. It is not surprising that they may choose to spend money on things other than medications, although you would expect this to be less prevalent in the posttransplant setting."

Patients with lower income, limited literacy, a higher number of chronic illnesses, and those taking more medications were more likely to have medication tradeoffs. Patients with tradeoffs were more than twice as likely to report non-adherence. Patients with tradeoffs had more hospitalizations after transplant than those who did not. The investigators suggested that the use of a tool similar to that used during the interviews conducted for this study would identify patients with cost-related barriers to proper medication adherence.

Dr. Serper added, "We need to be mindful of the effect of out-of-pocket costs on adherence and health outcomes in transplantation. Transplant centers routinely perform detailed psychosocial assessments prior to listing a patient for transplant, however, since financial situations may change, we may need to check in with patients more frequently after transplant, and intervene if needed."

Source: The American Association for the Study of Liver Diseases (AASLD)