Half Of Heart Patients Significantly Underuse Effective Heart Medications, Many Because Of Cost

Researchers who conducted the analysis said as many as 50 percent of patients significantly underused highly effective medications to prevent recurrence of heart attacks. Cost is a major factor in why patients don't take these medications.

Researchers examined Medicare beneficiaries over age 65 who received usual prescription drug coverage under the Part D program, with substantial cost-sharing, co-payments and out-of-pocket costs compared to full prescription drug coverage.

American College of Cardiology/American Heart Association guidelines recommend heart attack patients receive treatment with a beta-blocker, a statin cholesterol-lowering drug, an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), and aspirin. A combination of the drugs has reduced coronary heart disease death by 80 percent compared to placebo. This study examined the cost effectiveness of providing full Medicare coverage for these drugs.

At present, patients under the Part D program take some combination of beta blockers, ACE inhibitors or ARBs, statins and aspirin. Some patients take only one of these drugs; others use several, but on average patients are 50 percent adherent, researchers said.

"By reducing financial barriers to highly effective medications, we have the opportunity to not only increase adherence, but also decrease overall healthcare costs," said Niteesh Choudhry, M.D., Ph.D., lead author of the study and an assistant professor at Harvard Medical School and in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital in Boston, Mass.

Researchers used a sophisticated mathematical model to assess the post-heart attack patients, and determine costs, healthcare savings and length and quality of life.

They found that an average cost reduction of $2,500 per Medicare beneficiary would save society $1 billion for the approximately 400,000 Medicare beneficiaries who have a heart attack each year. The average cost of the drugs is more than $400 per year.

"Patients who adhere to these prescription medications are less likely to have adverse events, such as recurrent heart attacks, strokes, heart failure admissions and death, which cost a lot more than the drugs themselves," Choudhry said.

In the study, Medicare beneficiaries who received prescription drug coverage under Part D lived an average eight years and two months of Quality Adjusted Life Years (QALYs) after their initial heart attack. (Quality adjusted life years means that the length of life after a heart attack is adjusted by the quality of life.) Related medical costs were $114,000.

Those who received prescription drug coverage without deductibles or co-payments lived an average eight years and five months (QALY) with related medical costs of $111,600. Thus, full coverage results in greater life expectancy and less use of resources.

Compared to coverage under Part D, full coverage for preventive therapies would result in greater functional life expectancy of about four months and less resource use of about $2,500.

"The important point is that full prescription drug coverage may saves lives, improve quality of life and cost less money overall," Choudhry said.

He said that prescription drug costs increase under the full-coverage strategy because more people are using the medications. But in exchange, healthcare costs, including hospitalizations, procedures and death, decrease.

Choudhry said this model may provide a viable strategy for policy makers to consider and evidence for Medicare to rethink how they structure prescription drug benefits.

"Cost-sharing for prescription drugs may be counter-productive," he said. "Sometimes, it does not lead us to reduce the over-utilization of ineffective medications but rather it leads us to under-utilize highly effective medications."

Co-authors are: Amanda Patrick, M.S.; Elliott Antman, M.D.; Jerry Avorn, M.D.; and William Shrank, M.D., M.S.H.S.