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Full coverage of post-MI drugs reduced vascular event rates, out-of-pocket costs
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AHA Scientific Sessions 2011
ORLANDO, Fla. — Eliminating co-payments for post-MI secondary prevention drugs improved adherence, reduced rates of major vascular events, reduced patient out-of-pocket spending for drugs and other services without increasing insurer costs or total spending. However, the primary endpoint of reduced first major vascular event or revascularization was not met.
“There are a lot of implications of this study, and we believe that if we contribute to ongoing efforts to improve post-MI outcomes of results, as they’re presented, appear cost effective,” Niteesh K. Choudhry, MD, PhD, of the division of pharmacoepidemiology and pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, said at a press conference. “It’s a rarity for an intervention to actually improve patient affordability.”
Researchers enrolled patients discharged after MI and randomly assigned their insurance plan sponsors to full prescription coverage (1,494 sponsors; 2,845 patients) or usual prescription coverage (1,486 sponsors; 3,010 patients) for all statins, beta-blockers, angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers. The primary endpoint was the first major vascular event or revascularization; secondary endpoints included rates of medication adherence, total major vascular events or revascularization, first major vascular event and health expenditures.
Medication adherence rates were 4% to 6% higher in the full-coverage group compared with the usual-coverage group, which had rates ranging from 35.9% to 49.0% (P<.001). The primary outcome was not significantly different between the two groups (17.6 for full-coverage vs. 18.8 for usual-coverage; HR=0.93; 95% CI, 0.820-1.04).
Rates of total major vascular events or revascularization, as well as the rate of the first major vascular event, were significantly lower in the full-coverage group (21.5 vs. 23.3; HR=0.89; 95% CI, 0.90-0.99 and 11.0 vs. 12.8; HR=0.86; 95% CI, 0.74-0.99).
The intervention did not increase total spending ($66,088 for full-coverage and $71,778 for usual-coverage; relative spending=0.89; 95% CI, 0.50-1.56), and reduced patient costs for drugs and other services (relative spending=0.74; 95% CI, 0.68-0.80).
“The intervention we evaluated was easy and scalable and could be started as soon as tomorrow by insurers who choose to do so,” Choudhry said. “Even though adherence improved, it still remained very suboptimal in the full-coverage group, and this really highlights the need for other interventions to promote adherence. In turn, this should target other causes of non-adherence, such as complex treatment regimens, difficulties accessing medications, knowledge gaps, adverse effects and forgetfulness.” – by Stacey L. Fisher
For more information:
- Choudhry NK. LBCT.02. Presented at: American Heart Association Scientific Sessions 2011; Nov. 12-16; Orlando, Fla.
- Choudhry NK. N Engl J Med. 2011;doi:10.1056/NEJMsa1107913.
Disclosure: The study was supported by Sanofi-Aventis. Dr. Choudhry reports no relevant financial disclosures.
Overall, while the study only had a modest impact on adherence and, in fact, missed its primary endpoint, this is one time where I think that extra widespread adoption can be recommended. Reasons being, it did, in fact, improve outcomes on the total vascular events and the program essentially paid for it. But this doesn’t mention the other side, which was nicely brought up by Dr. Choudhry, that adherence in this country remains a huge problem for post-MI secondary prevention. Adherence rates remain under 50% for all these medicines individually, and, as we mentioned earlier, only one in 10 patients consistently took all three of these medicines that could save their life. Thus, further work on looking at novel adherence strategies is desperately needed.
– Eric D. Peterson, MD, MPH
Distinguished Professor of Medicine, Duke University
School of Medicine
Associate Director, Duke Clinical Research Institute
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