Research Horizons


For Kidney Transplantation, Investing in Medication Adherence Program Pays Off

Even if starting a medication adherence program cost $2.5 million to set up and $188,000 a year to maintain, doing so would still reduce the overall costs involved in providing and supporting kidney transplants to teens and young adults by reducing acute rejection rates and their associated costs.

And along the way, many people would live longer, healthier, more productive lives with their donated organs.

These are some of the findings from a study published Feb. 25, 2022, in the American Journal of Kidney Diseases. The analysis was led by Charles Varnell, MD, MS and David Hooper, MD, MS, at Cincinnati Children’s and Mark Eckman, MD, MS, at the University of Cincinnati.

The underappreciated toll of non-adherence

Approximately 40 percent of teens and young adults with kidney transplants do not follow their medication regimens as prescribed, usually due to developmentally appropriate behaviors, such as increased independence and risk-taking and marked changes in brain development.

In some cases, missing medications can lead to complete failure and loss of the transplanted organ, which results in returning to kidney dialysis and a dramatically reduced life expectancy. More frequently, however, non-adherence leads to increased rejection episodes that require hospital stays, numerous diagnostic tests and many hours of work from the healthcare team as well as the patients and families to address.

The costs of a poor transplant outcome are so high that even a 3% improvement in graft survival rates can be worth the effort to achieve. At Cincinnati Children’s, adopting a medication adherence program saved $9,106 per patient compared to routine care.

What is the MAPS program?

The Medication Adherence Promotion System (MAPS) at Cincinnati Children’s involves a multidisciplinary team of trained professionals working one-on-one with patients to overcome barriers to sticking with medication regimens.

Essential components include:

  • Adherence risk screening built into electronic health records (EHR) system.
  • Systematic assessment of barriers to taking medication
  • Patient-centered shared decision-making aids
  • Designation of team member responsibility to address specific barriers
  • Adherence promotion training for the clinical team
  • Optional electronic medication monitoring

“While the data from randomized controlled studies has clearly shown that similar medication adherence programs improve adherence, they haven’t been powered yet to show an improvement in clinical outcomes, such as rejection rates, nor have they been shown to be cost-effective,” says Varnell, first author for the study. “Using the clinical outcomes data from MAPS at Cincinnati Children’s (see Hooper et al, AJKD, 2022) we can now say that not only are these systems effective at reducing rejection rates, but that they are incredibly cost-effective and can be implemented into an existing clinical setting.”

Cincinnati Children’s co-authors and collaborators on this study included Kristin Rich, PhD, and Avani Modi, PhD, who were instrumental in creating the MAPS and are experts in medication adherence in children with chronic diseases.

Learn more about how MAPS was developed, and the clinical improvement achieved at Cincinnati Children’s:

Learn more about how the research team calculated the cost savings

Read a related article in Healio News

Publication Information
Original title: A Medication Adherence Promotion System to Reduce Late Kidney Allograft Rejection: A Quality Improvement Study
Published in: American Journal of Kidney Diseases
Publish date: Feb. 25, 2022
Read the Study

Research By

Charles Varnell Jr., MD, MS
Division of Nephrology and Hypertension
My colleagues and I are studying medication-taking behaviors in children and adolescents with kidney transplants. We seek to create systems of care that help support the patient and their family with taking medications as prescribed and that will lead to the best clinical outcomes.
David Hooper, MD, MS
Medical Director of Kidney Transplantation
My research includes developing healthcare delivery systems and information technology to track and improve all important health outcomes, developing systems to promote improved adherence and reduced risk of kidney transplant rejection, and understanding how genetics should influence patient care.
Avani Modi, PhD
Division of Behavioral Medicine and Clinical Psychology
In my laboratory, we look for ways to best measure adherence to treatment, identify adherence barriers, and then develop and test interventions to address adherence barriers.
Kristin Loiselle Rich, PhD
Division of Behavioral Medicine and Clinical Psychology
My research includes working to determine what can get in the way of children and families following their prescribed medical regimens.