Costs of providing antiplatelet medication for percutaneous coronary intervention patients.
OBJECTIVE
To propose a model in which insurers work with hospitals to provide a discharge supply of antiplatelet medication to patients receiving stents and to examine the cost implications of this strategy.


METHODS
A decision tree was modeled using data from previously published research. The study adopts an insurer's perspective.


METHODS
Data on patient delays in filling antiplatelet prescriptions and rates of associated adverse events were taken from published research. The costs of adverse events (death or acute myocardial infarction [AMI]) are taken from Healthcare Cost and Utilization Project estimates of hospital costs for diagnosis-related groups associated with AMI.


RESULTS
In the base case, expected costs totaled $1782 when stent implantation patients were provided with a discharge supply of medication and $1857 under the current standard of care, a difference of $75. Insurers can supply up to 60 days of medication without increasing total costs. The strategy of offering a discharge supply of medication is cost saving under a range of estimated rehospitalization costs and medication costs. However, this result is dependent on the ability of a discharge supply of medication to reduce rates of death or AMI.


CONCLUSIONS
Providing discharge supplies of antiplatelet medication resulted in lower overall costs for insurers in most of the cases modeled.
Department of Health Management and Policy, University of Michigan Health System, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA. natcar@umich.edu
Nathan W
NW
Carroll
Michael P
MP
Dorsch
D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000379:methods; D003663:Decision Trees; D003953:Diagnosis-Related Groups; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000706:statistics & numerical data; D018803:Models, Economic; D009203:Myocardial Infarction / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D010351:Patient Discharge / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D015607:Stents / Q000191:economics*; D014481:United States
D010975:Platelet Aggregation Inhibitors