Publication:

Effect of polypharmacy on healthcare costs in hospitalized patients diagnosed with hypertension and diabetes mellitus in a tertiary care teaching hospital

Background Hospitalised patients with diabetes mellitus and hypertension, particularly older adults, often have multiple comorbidities requiring polypharmacy. While the clinical consequences of polypharmacy are well documented, its economic impact, including healthcare expenditure, financial burden, and cost-related medication nonadherence, remains underexplored in resource-limited settings. Objectives of the study were to evaluate the association of polypharmacy and comorbidities with healthcare costs, financial burden, and cost-related medication non-adherence among hospitalised patients with diabetes mellitus and hypertension.

Methods A cross-sectional study was conducted among 180 hospitalised patients with diabetes mellitus and hypertension, with or without comorbidities, at a tertiary care teaching hospital. Data were collected using a validated proforma through patient interviews and medical records. Polypharmacy was defined as the use of ≥6 medications. Healthcare costs were categorized into direct medical, direct non-medical and indirect costs. Financial burden was estimated by comparing healthcare expenditure to income and cost-related medication nonadherence was assessed using a structured questionnaire. Statistical significance was set at p<0.05.

Results Polypharmacy was observed in 94.4% of patients. Those with polypharmacy incurred significantly higher direct medical (INR 8,380.24 versus INR 4,705; p<0.001), direct non-medical (INR 4,388.22 versus INR 1,174; p<0.001), and indirect costs (INR 2,638.82 versus INR 1,200; p=0.038). Patients with comorbidities had higher direct medical and non-medical costs, greater financial burden (70.29% versus 52.5%), and higher cost-related medication nonadherence (65.34% versus 32.5%).

Conclusions Polypharmacy and comorbidities substantially increase healthcare costs, financial burden, and cost-related medication nonadherence among hospitalised patients with diabetes and hypertension. Strategies to optimize medication use and improve financial support are essential to reduce these burdens.