Cardiovascular outcomes after a change in prescription policy for clopidogrel

Area of Science:

• Cardiovascular Medicine
• Health Policy
• Pharmacoeconomics

Background:

• Drug reimbursement policies can impact patient access to essential medications.
• Clopidogrel combined with aspirin is standard care for preventing thrombosis in patients with coronary stents after acute myocardial infarction.
• A Canadian province altered its policy for clopidogrel access from prior-authorization to limited-use.

Purpose of the Study:

• To evaluate the population-level impact of a policy change on clopidogrel access.
• To assess the effect on timely medication access for patients undergoing percutaneous coronary intervention (PCI) with stenting post-myocardial infarction.
• To determine the influence on cardiovascular outcomes and bleeding rates.

Main Methods:

• Population-based, retrospective, time-series analysis (April 2000 - March 2005) in Ontario, Canada.
• Included patients aged 65+ with acute myocardial infarction undergoing PCI with stenting.
• Primary outcome: 1-year composite of death, recurrent myocardial infarction, PCI, or coronary-artery bypass grafting; Secondary outcome: major bleeding.

Main Results:

• Clopidogrel use within 30 days increased from 35% to 88% post-policy change.
• Median time to first clopidogrel dispensing decreased from 9 days to 0 days.
• 1-year composite cardiovascular outcome decreased significantly from 15% to 11% (P=0.02); bleeding rates remained unchanged.

Conclusions:

• Eliminating the prior-authorization requirement for clopidogrel improved timely access.
• The policy change was associated with improved cardiovascular outcomes for patients receiving coronary stents.
• Less restrictive drug-reimbursement policies can positively affect patient health outcomes.