MANAGED CARE February 2007. ©MediMedia USA
Covering the full cost of combination therapies to prevent patients from having a second myocardial infarction might initially cost health insurers an additional $550 per patient, but then could wind up saving them an average of $1,731 per event, according to a study published in Health Affairs.
But insurers may be hesitant to offer full coverage due to high beneficiary turnover, which can be 20 percent to 30 percent in some cases.
"One insurer may pay for the drugs, while the other reaps the benefits of averted events," says Niteesh K. Choudhry, MD, coauthor of the study. He is an assistant professor of medicine at Harvard Medical School.
"The cost of providing the therapy to everyone, without any patient cost sharing, would be more than offset by the reductions in expenditures from heart attack, stroke, or death that would be avoided by increasing the use of therapy," Choudhry adds.
To determine the potential benefit of full coverage, Choudhry and colleagues observed post-MI rates of death, reinfarction, nonfatal stroke, readmissions for congestive heart failure (CHF), and medication adherence, and estimates of the treatment effect of combination pharmacotherapy, to calculate the expected number of events that would occur if post-MI patients did not receive any secondary prevention. The researchers then calculated the number of events that would be observed with full coverage.
On average, patients pay 32 percent of medication costs. Under the most optimistic assumptions, providing full coverage could increase medication compliance by as much as 26 percent, from 50 percent to 76 percent. For every 100 post-MI patients, full coverage could lead to 1.1 fewer deaths, 13.1 fewer nonfatal heart attacks, and 6.6 fewer readmissions for CHF. Even using conservative assumptions, providing full coverage would increase compliance from 50 percent to 63 percent and result in 0.4 fewer deaths, 5.7 fewer nonfatal heart attacks, and 0.5 fewer nonfatal strokes.
Although this study targeted hypertensive patients, a similar benefit has been demonstrated for other conditions, including diabetes and hyperlipidemia, Choudhry says.
Those conditions, like MI, have treatments that are highly effective, relatively inexpensive, and greatly underused.
"For conditions like acute MI, the benefit from enhanced drug coverage is probably seen within the first year and thus the situation may be different for this condition than for preventive health services that take longer to demonstrate a benefit."
Over a three-year period, the researchers estimate, providing post-MI patients with full coverage would save more than $5,600 per patient.