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Costs and benefits of free medications after myocardial infarction

Irfan A Dhalla1, Monique A Smith, Niteesh K Choudhry

  • 1Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.

Healthcare Policy = Politiques De Sante
|November 2, 2010
PubMed

Insights

Providing free secondary prevention medications to uninsured myocardial infarction patients significantly improves health outcomes and is cost-effective. This strategy enhances quality-adjusted life-years (QALYs) for patients and the healthcare system.

Area of Science:

  • Health Economics
  • Cardiovascular Medicine
  • Public Health Policy

Background:

  • Medication non-adherence after myocardial infarction (MI) limits the benefits of secondary prevention.
  • Financial barriers are a key driver of non-adherence.
  • This study assesses the economic impact of providing free medications to uninsured MI patients.

Purpose of the Study:

  • To evaluate the cost-effectiveness of full public coverage for secondary prevention medications for MI patients lacking private insurance.
  • To compare this intervention against the current healthcare system (status quo).

Main Methods:

  • Economic evaluation using decision analysis and Markov modelling.
  • Utilized Canadian data for cost and benefit estimations.
  • Primary outcome: incremental cost-effectiveness ratio (ICER) in cost per quality-adjusted life-year (QALY) gained.

Main Results:

  • Full public coverage increased QALYs (7.02 vs. 6.13) and healthcare costs ($20,423 vs. $17,173) compared to the status quo.
  • The ICER for full coverage was $3,663/QALY from the healthcare system perspective, robust under sensitivity analyses.
  • From a government perspective, the ICER was $12,350/QALY, sensitive to price elasticity but generally favorable.

Conclusions:

  • Full public coverage of secondary prevention medications is a cost-effective strategy for uninsured MI patients in Canada.
  • Public payers should consider implementing free medication programs to improve patient outcomes and reduce long-term healthcare burdens.
Abstract

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