title: Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction.
abstract: BACKGROUND
  Adherence to drugs that are prescribed after myocardial infarction remains suboptimal. Although eliminating patient cost sharing for secondary prevention increases adherence and reduces rates of major cardiovascular events, the long-term clinical and economic implications of this approach have not been adequately evaluated.
  
  
  RESULTS
  We developed a Markov model simulating a hypothetical cohort of commercially insured patients who were discharged from the hospital after myocardial infarction. Patients received β-blockers, renin-angiotensin system antagonists, and statins without cost sharing (full coverage) or at the current level of insurance coverage (usual coverage). Model inputs were extracted from the Post Myocardial Infarction Free Rx Event and Economic Evaluation trial and other published literature. The main outcome was an incremental cost-effectiveness ratio as measured by cost per quality-adjusted life year gained. Patients receiving usual coverage lived an average of 9.46 quality-adjusted life years after their event and incurred costs of $171,412. Patients receiving full coverage lived an average of 9.60 quality-adjusted life years and incurred costs of $167,401. Compared with usual coverage, full coverage would result in greater quality-adjusted survival (0.14 quality-adjusted life years) and less resource use ($4011) per patient. Our results were sensitive to alterations in the risk reduction for post-myocardial infarction events from full coverage.
  
  
  CONCLUSIONS
  Providing full prescription drug coverage for evidence-based pharmacotherapy to commercially insured post-myocardial infarction patients has the potential to improve health outcomes and save money from the societal perspective over the long-term.
  
  
  BACKGROUND
  https://www.clinicaltrials.gov. Unique identifier: NCT00566774.
authors.affiliation: From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.I., J.A., W.H.S., N.K.C.); Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, Biddeford, ME (K.I.); Office of Chief Medical Officer (M.T.) and Informatics (C.S.), Aetna, Hartford, CT; and CVS Health, Woonsocket, RI (W.H.S., T.B.).
authors.forename: Kouta
authors.initials: K
authors.lastname: Ito
authors.affiliation: From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.I., J.A., W.H.S., N.K.C.); Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, Biddeford, ME (K.I.); Office of Chief Medical Officer (M.T.) and Informatics (C.S.), Aetna, Hartford, CT; and CVS Health, Woonsocket, RI (W.H.S., T.B.).
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.affiliation: From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.I., J.A., W.H.S., N.K.C.); Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, Biddeford, ME (K.I.); Office of Chief Medical Officer (M.T.) and Informatics (C.S.), Aetna, Hartford, CT; and CVS Health, Woonsocket, RI (W.H.S., T.B.).
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.affiliation: From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.I., J.A., W.H.S., N.K.C.); Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, Biddeford, ME (K.I.); Office of Chief Medical Officer (M.T.) and Informatics (C.S.), Aetna, Hartford, CT; and CVS Health, Woonsocket, RI (W.H.S., T.B.).
authors.forename: Michele
authors.initials: M
authors.lastname: Toscano
authors.affiliation: From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.I., J.A., W.H.S., N.K.C.); Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, Biddeford, ME (K.I.); Office of Chief Medical Officer (M.T.) and Informatics (C.S.), Aetna, Hartford, CT; and CVS Health, Woonsocket, RI (W.H.S., T.B.).
authors.forename: Claire
authors.initials: C
authors.lastname: Spettel
authors.affiliation: From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.I., J.A., W.H.S., N.K.C.); Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, Biddeford, ME (K.I.); Office of Chief Medical Officer (M.T.) and Informatics (C.S.), Aetna, Hartford, CT; and CVS Health, Woonsocket, RI (W.H.S., T.B.).
authors.forename: Troyen
authors.initials: T
authors.lastname: Brennan
authors.affiliation: From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (K.I., J.A., W.H.S., N.K.C.); Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, Biddeford, ME (K.I.); Office of Chief Medical Officer (M.T.) and Informatics (C.S.), Aetna, Hartford, CT; and CVS Health, Woonsocket, RI (W.H.S., T.B.). nchoudhry@partners.org.
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000191:economics*; D003362:Cost-Benefit Analysis; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009203:Myocardial Infarction / Q000517:prevention & control*; D055502:Secondary Prevention / Q000191:economics*
chemical_list: D002317:Cardiovascular Agents
keywords: cost-benefit analysis; drug; epidemiology; myocardial infarction; prevention