Prevalence and economic burden of polypharmacy in a secondary healthcare facility in North-Central Nigeria: a cross-sectional study

Abstract

Polypharmacy, commonly defined as the concurrent use of five or more medications, is an increasing public health concern worldwide, particularly among patients with chronic diseases. Although the use of multiple medications may be clinically necessary, polypharmacy is associated with adverse drug reactions, poor adherence, increased healthcare utilization, and substantial financial burden. In low- and middle-income countries such as Nigeria, where healthcare financing depends largely on out-of-pocket payment, the economic impact of polypharmacy on patients can be considerable. This study assessed the prevalence and economic burden of polypharmacy among patients attending a secondary healthcare facility in North-Central Nigeria. A cross-sectional study was conducted at Offa Specialist Hospital, Kwara State, Nigeria. The study comprised a retrospective review of 2,000 prescriptions issued between January and June 2025 to determine the prevalence of polypharmacy and a prospective questionnaire survey involving 100 patients and 50 healthcare providers conducted between July and August 2025 to assess medication-related financial burden and perceptions of polypharmacy. Polypharmacy was observed in 37.0% of reviewed prescriptions (740/2,000). Of the prescriptions reviewed, 25.0% contained 5–9 medications (major polypharmacy) and 12.0% contained 10 or more medications (excessive polypharmacy). Most prescriptions (63.0%) contained 2–4 medications. Among patients surveyed, 37% reported spending more than ₦20,000 monthly on medications, and 79% indicated that medication cost constituted a financial burden. 66% of patients reported skipping or reducing medications due to cost, while 78% required financial assistance to obtain prescribed drugs. Among healthcare providers, 84% frequently encountered patients taking five or more medications, and all providers agreed that polypharmacy significantly increases treatment cost. Polypharmacy is prevalent and remains a significant prescribing concern in this secondary healthcare setting and imposes a substantial economic burden on patients. Strengthening medication review practices, promoting rational prescribing, and expanding health insurance coverage may help reduce unnecessary polypharmacy and its financial consequences in resource-limited settings.