Niteesh K. Choudhry, Kouta Ito, Jerry Avorn, William H. Shrank, Michele Toscano, Claire Spetell, and Troyen Brennan
K. Ito, J. Avorn, W. H. Shrank et al., “Long-Term Cost-Effectiveness of Providing Full Coverage for Preventive Medications After Myocardial Infarction,” Circulation: Cardiovascular Quality and Outcomes, published online May 5, 2015.
Clinical guidelines recommend that patients who suffer a myocardial infarction—otherwise known as a heart attack—undergo lifelong treatment with preventive medications, including beta-blockers, ACE inhibitors, or statins. Studies find that if commercial insurers cover these drugs at no cost to patients, adherence is improved and the rate of subsequent major cardiovascular events is reduced, without an increase in overall health spending. However, questions remain regarding the cost-effectiveness of this strategy over the long term.
Commonwealth Fund–supported researchers looked at a group of commercially insured heart attack patients who were prescribed statins, beta-blockers, or ACE inhibitors after being discharged from the hospital. One group received full coverage for their prescription drugs while the other had “usual” coverage that included copayments.
Patients receiving full coverage lived an average of 0.14 quality-adjusted life years longer and incurred $4,011 less in health care costs than those who had usual coverage. Better adherence to drug therapy in covered patients resulted in fewer major vascular events, including stroke, heart failure, and subsequent heart attacks. The resulting savings on emergency services and hospitalization more than offset the additional prescription drug costs.
Full prescription drug coverage after a heart attack improves drug adherence, leading to better lifetime health outcomes and substantial savings. The authors propose clinical trials to test the long-term impact of eliminating cost-sharing for high-value drugs for heart attack patients as well as those suffering from asthma, diabetes, and other chronic illnesses.