title: Should patients receive secondary prevention medications for free after a myocardial infarction? An economic analysis.
abstract: Taken in combination, aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and statins (combination pharmacotherapy) greatly reduce cardiac events. These therapies are underused, even among patients with drug insurance. Out-of-pocket spending is a key barrier to adherence. We estimated the impact of providing combination pharmacotherapy without cost sharing ("full coverage") to insured patients after a myocardial infarction (MI). Under base-case assumptions, compared to standard coverage, three years of full coverage will reduce mortality and reinfarction rates and will save 5,974 per patient. Our analysis suggests that covering combination therapy for such patients will save both lives and money.
authors.affiliation: Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA. nchoudhry@partners.org
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Elliott M
authors.initials: EM
authors.lastname: Antman
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use*; D001241:Aspirin / Q000191:economics / Q000627:therapeutic use*; D017047:Cost Sharing; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005382:Financing, Personal; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D019458:Insurance Coverage; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011306:Prescription Fees; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin