Costs of providing antiplatelet medication for percutaneous coronary intervention patients.

OBJECTIVES

To propose a model in which insurers work with hospitals to provide a discharge supply of antiplatelet medication to patients receiving stents and to examine the cost implications of this strategy.

STUDY DESIGN

A decision tree was modeled using data from previously published research. The study adopts an insurer's perspective.

METHODS

Data on patient delays in filling antiplatelet prescriptions and rates of associated adverse events were taken from published research. The costs of adverse events (death or acute myocardial infarction [AMI]) are taken from Healthcare Cost and Utilization Project estimates of hospital costs for diagnosis-related groups associated with AMI.

RESULTS

In the base case, expected costs totaled $1782 when stent implantation patients were provided with a discharge supply of medication and $1857 under the current standard of care, a difference of $75. Insurers can supply up to 60 days of medication without increasing total costs. The strategy of offering a discharge supply of medication is cost saving under a range of estimated rehospitalization costs and medication costs. However, this result is dependent on the ability of a discharge supply of medication to reduce rates of death or AMI.

CONCLUSIONS

Providing discharge supplies of antiplatelet medication resulted in lower overall costs for insurers in most of the cases modeled.