title: Comparative cost-effectiveness of interventions to improve medication adherence after myocardial infarction.
abstract: OBJECTIVE
  To evaluate the comparative cost-effectiveness of interventions to improve adherence to evidence-based medications among postmyocardial infarction (MI) patients.
  
  
  METHODS
  Cost-effectiveness analysis.
  
  
  METHODS
  We developed a Markov model simulating a hypothetical cohort of 65-year-old post-MI patients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained.
  
  
  METHODS
  Model inputs were extracted from published literature.
  
  
  RESULTS
  Compared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were $74,600, $69,200, $133,000, $113,000, and $142,900 per QALY gained, respectively. In an incremental analysis, only mailed education had an ICER of less than $100,000 per QALY and was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than $100 per month.
  
  
  CONCLUSIONS
  Mailed education and a polypill, once available, may be the cost-saving strategies for improving post-MI medication adherence.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
authors.forename: Kouta
authors.initials: K
authors.lastname: Ito
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Patrick
authors.forename: Troyen A
authors.initials: TA
authors.lastname: Brennan
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Antman
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D004359:Drug Therapy, Combination; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009203:Myocardial Infarction / Q000188:drug therapy*; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods; D019338:Polypharmacy; D019057:Quality-Adjusted Life Years; D016903:Drug Monitoring
chemical_list: D002317:Cardiovascular Agents