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Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction
Kouta Ito1, Jerry Avorn1, William H Shrank1
1From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.I., J.A., W.H.S., N.K.C.); Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, Biddeford, ME (K.I.); Office of Chief Medical Officer (M.T.) and Informatics (C.S.), Aetna, Hartford, CT; and CVS Health, Woonsocket, RI (W.H.S., T.B.).
Insights
Eliminating prescription drug costs for heart attack survivors improves adherence and outcomes. Full coverage for evidence-based medications saves money and enhances quality of life long-term.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Pharmacoeconomics
Background:
- Suboptimal adherence to post-myocardial infarction (MI) medications is a significant clinical challenge.
- Eliminating patient cost-sharing for secondary prevention medications can improve adherence and reduce cardiovascular events.
- The long-term clinical and economic impact of removing cost-sharing for these medications requires thorough evaluation.
Purpose of the Study:
- To evaluate the long-term clinical and economic implications of eliminating patient cost-sharing for secondary prevention medications after myocardial infarction.
- To compare the cost-effectiveness of full prescription drug coverage versus usual coverage for post-MI patients.
Main Methods:
- A Markov model was developed to simulate a hypothetical cohort of commercially insured patients post-MI.
- The model compared outcomes for patients receiving medications (β-blockers, renin-angiotensin system antagonists, statins) with full cost-sharing versus usual insurance coverage.
- Model inputs were derived from the Post Myocardial Infarction Free Rx Event and Economic Evaluation trial and other published literature.
Main Results:
- Patients receiving full coverage lived longer (9.60 QALYs vs. 9.46 QALYs) and incurred lower overall costs ($167,401 vs. $171,412) compared to usual coverage.
- Full coverage resulted in 0.14 additional quality-adjusted life years (QALYs) and saved $4011 per patient.
- Results were sensitive to the impact of full coverage on reducing post-MI event risk.
Conclusions:
- Full prescription drug coverage for evidence-based pharmacotherapy in commercially insured post-MI patients can improve health outcomes.
- This approach has the potential for long-term cost savings from a societal perspective.
- Removing financial barriers to essential medications is a viable strategy for improving cardiovascular care and economic efficiency.
Background:
Adherence to drugs that are prescribed after myocardial infarction remains suboptimal. Although eliminating patient cost sharing for secondary prevention increases adherence and reduces rates of major cardiovascular events, the long-term clinical and economic implications of this approach have not been adequately evaluated.
Methods And Results:
We developed a Markov model simulating a hypothetical cohort of commercially insured patients who were discharged from the hospital after myocardial infarction. Patients received β-blockers, renin-angiotensin system antagonists, and statins without cost sharing (full coverage) or at the current level of insurance coverage (usual coverage). Model inputs were extracted from the Post Myocardial Infarction Free Rx Event and Economic Evaluation trial and other published literature. The main outcome was an incremental cost-effectiveness ratio as measured by cost per quality-adjusted life year gained. Patients receiving usual coverage lived an average of 9.46 quality-adjusted life years after their event and incurred costs of $171,412. Patients receiving full coverage lived an average of 9.60 quality-adjusted life years and incurred costs of $167,401. Compared with usual coverage, full coverage would result in greater quality-adjusted survival (0.14 quality-adjusted life years) and less resource use ($4011) per patient. Our results were sensitive to alterations in the risk reduction for post-myocardial infarction events from full coverage.
Conclusions:
Providing full prescription drug coverage for evidence-based pharmacotherapy to commercially insured post-myocardial infarction patients has the potential to improve health outcomes and save money from the societal perspective over the long-term.
Clinical Trial Registration Information:
https://www.clinicaltrials.gov. Unique identifier: NCT00566774.
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