title: The impact of reducing cardiovascular medication copayments on health spending and resource utilization.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of reductions in statin and clopidogrel copayments on cardiovascular resource utilization, major coronary events, and insurer spending.
  
  
  BACKGROUND
  Copayments are widely used to contain health spending but cause patients to reduce their use of essential cardiovascular medications. Reducing copayments for post-myocardial infarction secondary prevention has beneficial effects, but the impact of this strategy for lower risk patients and other drugs remains unclear.
  
  
  METHODS
  An evaluation was conducted of health care spending and resource use by a large self-insured employer that reduced statin copayments for patients with diabetes or vascular disease and reduced clopidogrel copayments for all patients prescribed this drug. Eligible individuals in the intervention company (n = 3,513) were compared with a control group from other companies without such a policy (n = 49,803). Analyses were performed using segmented regression models with generalized estimating equations.
  
  
  RESULTS
  Lowering copayments was associated with significant reductions in rates of physician visits (relative change: statin users 0.80; 95% confidence interval [CI]: 0.57 to 0.98; clopidogrel users: 0.87; 95% CI: 0.59 to 0.96) and hospitalizations and emergency department admissions (relative change: statin users 0.90; 95% CI: 0.80 to 0.92; clopidogrel users: 0.89; 95% CI: 0.74 to 0.90) although not major coronary events. Patient out-of-pocket spending for drugs and other medical services decreased (relative change: statin users 0.79; 95% CI: 0.75 to 0.83; clopidogrel users 0.74; 95% CI: 0.66 to 0.82). Providing more generous coverage did not increase overall spending (relative change: statin users 1.03; 95% CI: 0.97 to 1.09; clopidogrel users 0.94; 95% CI: 0.87 to 1.03).
  
  
  CONCLUSIONS
  Lowering copayments for statins and clopidogrel was associated with reductions in health care resource use and patient out-of-pocket spending. The policy appeared cost neutral with respect to overall health spending.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02120, USA. nchoudhry@partners.org
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fischer
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Avorn
authors.forename: Joy L
authors.initials: JL
authors.lastname: Lee
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Christine
authors.initials: C
authors.lastname: Berman
authors.forename: Saira
authors.initials: S
authors.lastname: Jan
authors.forename: Joyce
authors.initials: J
authors.lastname: Lii
authors.forename: John J
authors.initials: JJ
authors.lastname: Mahoney
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D000368:Aged; D002309:Cardiology / Q000379:methods; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000191:economics*; D016022:Case-Control Studies; D000077144:Clopidogrel; D017047:Cost Sharing / Q000191:economics; D004358:Drug Therapy / Q000191:economics; D019317:Evidence-Based Medicine; D005260:Female; D017048:Health Care Costs; D018166:Health Care Reform; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics; D010975:Platelet Aggregation Inhibitors / Q000191:economics; D012306:Risk; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000191:economics; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine