Providing appropriate preventive drugs to patients free of charge following a heart attack would increase survival and save billions annually, a cost-effectiveness analysis finds. From MedPage Today.
Providing appropriate preventive drugs to patients free of charge following a heart attack would increase survival and save billions annually, a cost-effectiveness analysis found.
Compared with usual coverage, providing beta-blockers, angiotensin-converting enzyme inhibitors (ACE I) or angiotensin receptor blockers (ARB), statins, and aspirin without cost to patients would result in greater quality-adjusted survival (0.14 quality-adjusted life years) and less cost ($4,011 savings) per patient.
This cost reduction would save society almost $2 billion annually, researcher Niteesh K. Choudhry, MD, of Harvard Medical School and Brigham and Women's Hospital, Boston, and colleagues wrote in the journal Circulation: Cardiovascular Quality and Outcomes.
The researchers constructed a Markov model to estimate long-term outcomes and costs among privately insured patients enrolled in several trials, including their own previously reported health policy study known as Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE).
In that study, eliminating copayments for beta-blockers, ACE inhibitors, ARBs, and statins recommended post-MI was found to improve drug adherence and reduce major vascular events (but not revascularization) without increasing overall cost spending, but follow-up was just over 1 year.
No-Cost Preventive Meds and the ACA
Their newly published cost-effectiveness analysis extended this follow-up to 5 years of intervention.
The finding that this intervention would save both lives and money could have major implications for both private health insurers and public policymakers as they develop cost-sharing strategies based on value-based insurance design (VBID), the researchers noted.
The Patient Protection and Affordable Care Act (ACA) requires health insurers to provide coverage for specific preventive services, such as mammograms and blood pressure screening, without cost sharing, but this does not, as yet, include most drugs used to prevent disease.
"Under-use of effective drugs is a major contribution to suboptimal disease control and poor outcomes," Choudhry and colleagues wrote, citing a 2007 study which found a 10% increase in patient cost sharing to be associated with increases in the use of costly health services, such as an emergency department visit, and decreases in prescription drug use.
"In the current policy climate where efforts to improve healthcare quality must be coupled with efforts to contain costs, our analysis extended the growing evidence that VBID is a promising approach that could be easily scaled to large populations to improve the quality of care for post-MI patients," they wrote.
In an editorial, Steven Farmer, MD, PhD, and William Borden, MD, of George Washington University School of Medicine, Washington, D.C., wrote that the timing of the new study, "could not be better."
"The rapid growth in high-deductive insurance plans creates an urgency to identify areas where low or no cost-sharing makes sense, even for high-deductible plans," they wrote.
Free Post MI Heart Drugs: 'Everybody Wins'
In a telephone interview, Farmer told MedPage Today that the cost-effectiveness analysis makes a strong case for providing appropriate preventive drugs to patients post MI free of charge.
"Basically everybody wins," he said. "Patients win because survival is improved and they are not paying for needed medications, and payers win because their overall costs are less."
He noted that while the ACA has extended health insurance coverage to an estimated 16.4 million new patients, a large percentage of these newly insured people have opted for the lowest cost plans with the highest deductibles.
"Even in the case of low-cost, generic medications, if a patient is taking four or five or even more drugs a month the costs can add up," Farmer said. "Even a $5 or $10 copay will act as a barrier to stay on medications for some patients. The people that can least afford them are being hit with the highest copays, and that can distort judgment."
In their editorial, Farmer and Borden noted that if all, and not just some private insurers implement proven interventions like those provided in MI FREEE, patients with high-deductible insurance plans will be less inclined to switch providers frequently -- a practice known as churn.
"Although challenges to VBID certainly exist, the MI FREEE and follow-up study show that providing free medications post MI is smart, plain and simple," they wrote. "The medical community should continue to look for situations where removing financial barriers to evidence-based care is effective in improving healthcare value, and then work to remove those barriers."
From our partners at MedPage Today.