Eliminating out-of-pocket drug costs may improve outcomes after myocardial infarction--but at what cost to Medicare?

A standard four-drug regimen of aspirin, a beta-blocker, a lipid-lowering agent, and an angiotensin-converting-enzyme inhibitor or angiotensin-receptor blocker improves outcomes in survivors of myocardial infarction (MI), but adherence to this regimen is often poor. Choudhry et al. used a computer model to simulate the effectiveness and cost of improving medication adherence by eliminating out-of-pocket costs for the four-drug regimen in a hypothetical cohort of 65-year-old Medicare beneficiaries with MI. Based on the model's main assumptions, eliminating cost sharing for the regimen would be cost saving from a societal perspective, but would cost Medicare $7,182 per quality-adjusted life year. The results of the Choudhry et al. analysis suggest that improving adherence to a secondary prevention strategy by eliminating out-of-pocket costs for standard post-MI medications would be a cost-effective Medicare policy.