Walker Andrew L, Sorensen Teshia, Gabriel Paolo P, Sledge Tyler, Morshedzadeh Jack H, Owan Theophilus, Shah Rashmee U
University of Utah School of Medicine, Department of Internal Medicine, Salt Lake City, USA.
University of Utah Health, Pharmacy Services, Salt Lake City, USA.
J Am Coll Clin Pharm. 2018 Dec;1(2):58-61. doi: 10.1002/jac5.1010. Epub 2018 Apr 14.
Data from randomized controlled trials support a mortality benefit with ticagrelor versus clopidogrel among patients with acute myocardial infarction (AMI). Many healthcare providers preferentially treat patients with AMI with ticagrelor. The goal of this study was to determine the association between out-of-pocket drug costs and ticagrelor continuation compared with switching to clopidogrel among patients hospitalized for AMI, following a pharmacist-led discussion on outpatient co-payment costs for ticagrelor.
Retrospective cohort study.
A tertiary care academic medical center.
Patients hospitalized with AMI between February 15, 2015 and January 23, 2017, who were loaded with ticagrelor on presentation.
Of 143 patients with AMI loaded with ticagrelor, 70 (49%) switched to clopidogrel after cost discussion. The median monthly ticagrelor co-payment was $268.29 (interquartile range [IQR] $45-$350) for switchers, versus $18 (IQR $6-$24) for non-switchers (p<0.001). Patients with co-payments of $100/month or more were 3.4 times more likely to switch to clopidogrel (relative risk 3.41, 95% confidence interval 2.12 to 5.47), compared with patients with co-payments of less than $100/month.
Following a discussion of outpatient costs, half of patients with AMI switched from ticagrelor to clopidogrel when given the choice.
随机对照试验的数据表明，在急性心肌梗死（AMI）患者中，替格瑞洛较氯吡格雷可降低死亡率。许多医疗服务提供者更倾向于用替格瑞洛治疗AMI患者。本研究的目的是确定在药师主导的关于替格瑞洛门诊自付费用的讨论之后，AMI住院患者的自付药物费用与继续使用替格瑞洛而非换用氯吡格雷之间的关联。
回顾性队列研究。
一家三级医疗学术医学中心。
2015年2月15日至2017年1月23日期间因AMI住院且入院时接受替格瑞洛负荷剂量治疗的患者。
在143例接受替格瑞洛负荷剂量治疗的AMI患者中，70例（49%）在费用讨论后换用了氯吡格雷。换用者替格瑞洛的月自付费用中位数为268.29美元（四分位间距[IQR]为45 - 350美元），未换用者为18美元（IQR为6 - 24美元）（p<0.001）。月自付费用在100美元及以上的患者换用氯吡格雷的可能性是月自付费用低于100美元患者的3.4倍（相对风险3.41，95%置信区间2.12至5.47）。
在讨论门诊费用后，一半的AMI患者在有选择的情况下从替格瑞洛换用了氯吡格雷。
