Barry Luke E, Basu Sanjay, Wang May, Nianogo Roch A
Fielding School of Public Health, University of California, Los Angeles.
Research and Development, Waymark, San Francisco.
Milbank Q. 2025 Jun;103(2):390-439. doi: 10.1111/1468-0009.70004. Epub 2025 Mar 21.
Policy Points Evidence suggests Medicaid expansion has improved cardiovascular disease (CVD) outcomes, especially among those of lower socioeconomic status. However, less is known about the cost-effectiveness of Medicaid in achieving these outcomes and reducing CVD disparities. We found that Medicaid expansion resulted in a reduction in CVD incidence, suggesting that it was cost-effective in reducing CVD outcomes and equity enhancing but with a high degree of uncertainty. Policymakers will need to trade-off among a number of different factors in consideration of the value of Medicaid including health (especially in treating the chronically ill), financial protection, reduced uncompensated care, and health disparities.
Evidence suggests Medicaid expansion has improved cardiovascular disease (CVD) outcomes, especially among those of lower socioeconomic status. However, less is known about the cost-effectiveness of Medicaid in achieving these outcomes and reducing CVD disparities. We use distributional cost-effectiveness analysis methods to examine the efficiency and equitability of Medicaid expansion in reducing CVD outcomes.
A Monte Carlo Markov-chain microsimulation model was developed to examine lifetime changes in CVD outcomes and disparities as a result of expansion and the associated cost and quality-of-life impacts.
Medicaid expansion was associated with a reduction of 11 myocardial infarctions, eight strokes, and four CVD deaths per 100,000 person-years compared with no expansion. The largest reductions occurred for those with lower income and education, and those of Black and Hispanic race/ethnicity. We found that the benefits of expansion generally balanced out the costs while redistributing health from higher to lower income groups. In probabilistic sensitivity analysis, we found-using a health opportunity cost threshold of $150,000-that Medicaid expansion was cost-effective in reducing CVD outcomes 53% of the time and both cost-effective (efficient) and equity enhancing 26% to 29% of the time.
Medicaid expansion resulted in a reduction in CVD incidence, suggesting that it was both cost-effective and equity enhancing in reducing CVD outcomes but with a high degree of uncertainty.
政策要点 有证据表明，医疗补助计划的扩大改善了心血管疾病（CVD）的治疗效果，尤其是在社会经济地位较低的人群中。然而，对于医疗补助计划在实现这些效果以及减少心血管疾病差异方面的成本效益，我们了解得较少。我们发现，医疗补助计划的扩大导致心血管疾病发病率降低，这表明它在降低心血管疾病治疗效果和促进公平方面具有成本效益，但存在高度不确定性。政策制定者在考虑医疗补助计划的价值时，需要在许多不同因素之间进行权衡，这些因素包括健康（尤其是治疗慢性病）、经济保护、减少无补偿医疗以及健康差异。
有证据表明，医疗补助计划的扩大改善了心血管疾病（CVD）的治疗效果，尤其是在社会经济地位较低的人群中。然而，对于医疗补助计划在实现这些效果以及减少心血管疾病差异方面的成本效益，我们了解得较少。我们使用分布成本效益分析方法来检验医疗补助计划扩大在降低心血管疾病治疗效果方面的效率和公平性。
开发了一个蒙特卡洛马尔可夫链微观模拟模型，以检验因扩大计划而导致的心血管疾病治疗效果和差异的终生变化，以及相关的成本和生活质量影响。
与未扩大计划相比，医疗补助计划的扩大与每10万人年减少11次心肌梗死、8次中风和4例心血管疾病死亡相关。收入和教育水平较低以及黑人与西班牙裔种族/族裔人群的减少幅度最大。我们发现，扩大计划的好处总体上抵消了成本，同时将健康从高收入群体重新分配到低收入群体。在概率敏感性分析中，我们发现——使用15万美元的健康机会成本阈值——医疗补助计划的扩大在53%的时间内具有成本效益，在26%至29%的时间内既具有成本效益（高效）又促进公平。
医疗补助计划的扩大导致心血管疾病发病率降低，这表明它在降低心血管疾病治疗效果方面既具有成本效益又促进公平，但存在高度不确定性。
