Does providing full drug coverage for secondary prevention medications improve quality-adjusted life-years and reduce costs in post-myocardial infarction Medicare beneficiaries?
Providing full coverage for secondary prevention combination therapy to post-MI Medicare beneficiaries is projected to save both lives and money from a societal perspective.
BACKGROUND: Effective therapies for the secondary prevention of coronary heart disease-related events are significantly underused, and attempts to improve adherence have often yielded disappointing results. Elimination of patient out-of-pocket costs may be an effective strategy to enhance medication use. We sought to estimate the incremental cost-effectiveness of providing full coverage for aspirin, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins (combination pharmacotherapy) to individuals enrolled in the Medicare drug benefit program after acute myocardial infarction. METHODS AND RESULTS: We created a Markov cost-effectiveness model to estimate the incremental cost-effectiveness of providing Medicare beneficiaries with full coverage for combination pharmacotherapy compared with current coverage under the Medicare Part D program. Our analysis was conducted from the societal perspective and considered a lifetime time horizon. In a sensitivity analysis, we repeated our analysis from the perspective of Medicare. In the model, post-myocardial infarction Medicare beneficiaries who received usual prescription drug coverage under the Part D program lived an average of 8. 21 quality-adjusted life-years after their initial event, incurring coronary heart disease-related medical costs of 114, 000. Those who received prescription drug coverage without deductibles or copayments lived an average of 8. 56 quality-adjusted life-years and incurred 111, 600 in coronary heart disease-related costs. Compared with current prescription drug coverage, full coverage for post-myocardial infarction secondary prevention therapies would result in greater functional life expectancy (0. 35 quality-adjusted life-year) and less resource use (2500). From the perspective of Medicare, full drug coverage was highly cost-effective (7182/quality-adjusted life-year) but not cost saving. CONCLUSIONS: Our analysis suggests that providing full coverage for combination therapy to post-myocardial infarction Medicare beneficiaries would save both lives and money from the societal perspective.
Choudhry et al. (Wed,) studied this question.
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