Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes.
BACKGROUND
Angiotensin-converting enzyme (ACE) inhibitors slow renal disease progression and reduce cardiac morbidity and mortality in patients with diabetes. Patients' out-of-pocket costs pose a barrier to using this effective therapy.


OBJECTIVE
To estimate the cost-effectiveness to Medicare of first-dollar coverage (no cost sharing) of ACE inhibitors for beneficiaries with diabetes.


METHODS
Markov model with costs and benefits discounted at 3%.


METHODS
Published literature and Medicare claims data.


METHODS
65-year-old Medicare beneficiary with diabetes.


METHODS
Lifetime.


CONCLUSIONS
Medicare and societal.


METHODS
We evaluated Medicare first-dollar coverage of ACE inhibitors compared with current practice (no coverage) and the new Medicare drug benefit.


METHODS
Costs (2003 U.S. dollars), quality-adjusted life-years (QALYs), life-years, and incremental cost-effectiveness.


RESULTS
Compared with current practice, first-dollar coverage of ACE inhibitors saved both lives and money (0.23 QALYs gained and 1606 USD saved per Medicare beneficiary). Compared with the new Medicare drug benefit, first-dollar coverage remained a dominant strategy (0.15 QALYs gained, 922 USD saved).


RESULTS
Results were most sensitive to our estimate of increase in ACE inhibitor use; however, if ACE inhibitor use increased by only 7.2% (from 40% to 47.2%), first-dollar coverage would remain life-saving at no net cost to Medicare. In analyses conducted from the societal perspective, benefits were similar and cost savings were larger.


CONCLUSIONS
Results depend on accuracy of the underlying data and assumptions. The effect of more generous drug coverage on medication adherence is uncertain.


CONCLUSIONS
Medicare first-dollar coverage of ACE inhibitors for beneficiaries with diabetes appears to extend life and reduce Medicare program costs. A reduction in program costs may result in more money to spend on other health care needs of the elderly.
Rosen
Allison B
AB
Division of General Medicine, University of Michigan Health Systems, 300 North Ingalls, Suite 7E10, Ann Arbor, MI 48109, USA. abrosen@umich.edu
Hamel
Mary Beth
MB
Weinstein
Milton C
MC
Cutler
David M
DM
Fendrick
A Mark
AM
Vijan
Sandeep
S
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000517:prevention & control*; D003928:Diabetic Nephropathies / Q000517:prevention & control*; D018450:Disease Progression; D016527:Drug Costs; D006801:Humans; D008390:Markov Chains; D006278:Medicare / Q000191:economics*; D010349:Patient Compliance; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D014481:United States
D000806:Angiotensin-Converting Enzyme Inhibitors