Ito Kouta, Avorn Jerry, Shrank William H, Toscano Michele, Spettel Claire, Brennan Troyen, Choudhry Niteesh K
From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.I., J.A., W.H.S., N.K.C.); Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, Biddeford, ME (K.I.); Office of Chief Medical Officer (M.T.) and Informatics (C.S.), Aetna, Hartford, CT; and CVS Health, Woonsocket, RI (W.H.S., T.B.).
Circ Cardiovasc Qual Outcomes. 2015 May;8(3):252-9. doi: 10.1161/CIRCOUTCOMES.114.001330. Epub 2015 May 5.
Adherence to drugs that are prescribed after myocardial infarction remains suboptimal. Although eliminating patient cost sharing for secondary prevention increases adherence and reduces rates of major cardiovascular events, the long-term clinical and economic implications of this approach have not been adequately evaluated.
We developed a Markov model simulating a hypothetical cohort of commercially insured patients who were discharged from the hospital after myocardial infarction. Patients received β-blockers, renin-angiotensin system antagonists, and statins without cost sharing (full coverage) or at the current level of insurance coverage (usual coverage). Model inputs were extracted from the Post Myocardial Infarction Free Rx Event and Economic Evaluation trial and other published literature. The main outcome was an incremental cost-effectiveness ratio as measured by cost per quality-adjusted life year gained. Patients receiving usual coverage lived an average of 9.46 quality-adjusted life years after their event and incurred costs of $171,412. Patients receiving full coverage lived an average of 9.60 quality-adjusted life years and incurred costs of $167,401. Compared with usual coverage, full coverage would result in greater quality-adjusted survival (0.14 quality-adjusted life years) and less resource use ($4011) per patient. Our results were sensitive to alterations in the risk reduction for post-myocardial infarction events from full coverage.
Providing full prescription drug coverage for evidence-based pharmacotherapy to commercially insured post-myocardial infarction patients has the potential to improve health outcomes and save money from the societal perspective over the long-term.
https://www.clinicaltrials.gov. Unique identifier: NCT00566774.
心肌梗死后患者对所开药物的依从性仍不理想。虽然消除二级预防的患者费用分担可提高依从性并降低主要心血管事件的发生率，但这种方法的长期临床和经济影响尚未得到充分评估。
我们开发了一个马尔可夫模型，模拟一组假设的商业保险患者，这些患者在心肌梗死后出院。患者接受β受体阻滞剂、肾素 - 血管紧张素系统拮抗剂和他汀类药物，要么无费用分担（全额覆盖），要么按当前保险覆盖水平（常规覆盖）。模型输入数据取自心肌梗死后免费药物治疗事件与经济评估试验及其他已发表文献。主要结局是增量成本效益比，以每获得一个质量调整生命年的成本来衡量。接受常规覆盖的患者在事件发生后平均享有9.46个质量调整生命年，产生的费用为171,412美元。接受全额覆盖的患者平均享有9.60个质量调整生命年，产生的费用为167,401美元。与常规覆盖相比，全额覆盖将使每位患者获得更高的质量调整生存期（0.14个质量调整生命年）并减少资源使用（4011美元）。我们的结果对全额覆盖使心肌梗死后事件风险降低的变化较为敏感。
从社会角度来看，为商业保险的心肌梗死后患者提供基于证据的药物治疗的全额处方药覆盖，有可能改善健康结局并长期节省资金。
