September 21, 2012Open Access
View Full PaperComparative Cost‐Effectiveness of Interventions to Improve Medication Adherence after Myocardial Infarction
Key Result
Mailed education improved health outcomes and reduced spending compared with usual care, emerging as the optimal strategy with an incremental cost-effectiveness ratio of less than $100,000 per QALY.
Key Points
- This research aims to assess the cost-effectiveness of various interventions to enhance medication adherence in patients after myocardial infarction.
- Developed a Markov model to simulate a hypothetical cohort of 65-year-old post-MI patients.
- Evaluated mailed education, disease management, polypill use, and combinations of these interventions.
- Performed analysis from a societal perspective over a lifetime horizon.
- Mailed education improved health outcomes and reduced spending compared to usual care.
- The ICER for mailed education was less than $100,000 per QALY, making it the optimal strategy.
- Polypill use combined with mailed education could be cost-effective if the price is below $100 per month.
Structured PICO
Are mailed education, disease management, or polypill use cost-effective for improving medication adherence in post-MI patients compared to usual care?
P
Population
A hypothetical cohort of 65-year-old post-MI patients prescribed secondary prevention medications, modeled over a lifetime horizon.
I
Intervention
Mailed education, disease management, polypill use, and combinations of these interventions
C
Comparator
Usual care
O
Outcome
Incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained
Mailed education is a cost-saving strategy to improve medication adherence in post-MI patients, while polypills could become cost-effective if priced under $100 per month.
Abstract
OBJECTIVE: To evaluate the comparative cost-effectiveness of interventions to improve adherence to evidence-based medications among postmyocardial infarction (MI) patients. DATA SOURCES/STUDY SETTING: Cost-effectiveness analysis. STUDY DESIGN: We developed a Markov model simulating a hypothetical cohort of 65-year-old post-MI patients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained. DATA COLLECTION/EXTRACTION METHODS: Model inputs were extracted from published literature. PRINCIPAL FINDINGS: Compared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were 74, 600, 69, 200, 133, 000, 113, 000, and 142, 900 per QALY gained, respectively. In an incremental analysis, only mailed education had an ICER of less than 100, 000 per QALY and was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than 100 per month. CONCLUSIONS: Mailed education and a polypill, once available, may be the cost-saving strategies for improving post-MI medication adherence.