title: Eliminating out-of-pocket drug costs may improve outcomes after myocardial infarction--but at what cost to Medicare?
abstract: A standard four-drug regimen of aspirin, a beta-blocker, a lipid-lowering agent, and an angiotensin-converting-enzyme inhibitor or angiotensin-receptor blocker improves outcomes in survivors of myocardial infarction (MI), but adherence to this regimen is often poor. Choudhry et al. used a computer model to simulate the effectiveness and cost of improving medication adherence by eliminating out-of-pocket costs for the four-drug regimen in a hypothetical cohort of 65-year-old Medicare beneficiaries with MI. Based on the model's main assumptions, eliminating cost sharing for the regimen would be cost saving from a societal perspective, but would cost Medicare $7,182 per quality-adjusted life year. The results of the Choudhry et al. analysis suggest that improving adherence to a secondary prevention strategy by eliminating out-of-pocket costs for standard post-MI medications would be a cost-effective Medicare policy.
authors.affiliation: Division of General Internal Medicine, Columbia University, New York, NY 10032, USA. aem35@columbia.edu
authors.forename: Andrew
authors.initials: A
authors.lastname: Moran
authors.forename: Lee
authors.initials: L
authors.lastname: Goldman
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000191:economics / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D001241:Aspirin / Q000191:economics / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000191:economics* / Q000627:therapeutic use*; D003198:Computer Simulation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D006801:Humans; D000960:Hypolipidemic Agents / Q000191:economics / Q000627:therapeutic use; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D006278:Medicare / Q000191:economics*; D018803:Models, Economic; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics*; D010349:Patient Compliance; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D000960:Hypolipidemic Agents; D001241:Aspirin