Irfan A Dhalla1, Monique A Smith, Niteesh K Choudhry, Avram E Denburg. 1. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
Abstract
BACKGROUND: Although combination pharmacotherapy after myocardial infarction dramatically reduces morbidity and mortality, the full benefits of secondary prevention medications remain unrealized owing to medication non-adherence. Because financial barriers are a major determinant of non-adherence, we examined the costs and benefits of providing free medications to myocardial infarction patients who do not have private insurance and are ineligible for substantial public coverage. METHODS: An economic evaluation combining decision analysis and Markov modelling was conducted to compare full public coverage of secondary prevention medications with the status quo. Costs and benefits were estimated using Canadian data wherever possible. The main outcome was the incremental cost-effectiveness ratio measured in cost per quality-adjusted life-year (QALY) gained. RESULTS: From the perspective of the publicly funded healthcare system, full coverage resulted in greater quality-adjusted survival than the status quo (7.02 vs. 6.13 QALYs) but at increased cost ($20,423 vs. $17,173). The incremental cost-effectiveness ratio (ICER) for full coverage compared to the status quo was $3,663/QALY. This result was robust to a wide range of sensitivity analyses. In a secondary analysis from the perspective of government, the ICER for full coverage compared to the status quo was $12,350/QALY. In this analysis, the ICER was sensitive to changes in price elasticity, but remained below $50,000/QALY as long as the elasticity remained below -0.035. INTERPRETATION: Public payers in Canada should consider providing secondary prevention medications to myocardial infarction patients without private insurance free of charge. Full public coverage is cost-effective compared to the status quo.
BACKGROUND: Although combination pharmacotherapy after myocardial infarction dramatically reduces morbidity and mortality, the full benefits of secondary prevention medications remain unrealized owing to medication non-adherence. Because financial barriers are a major determinant of non-adherence, we examined the costs and benefits of providing free medications to myocardial infarctionpatients who do not have private insurance and are ineligible for substantial public coverage. METHODS: An economic evaluation combining decision analysis and Markov modelling was conducted to compare full public coverage of secondary prevention medications with the status quo. Costs and benefits were estimated using Canadian data wherever possible. The main outcome was the incremental cost-effectiveness ratio measured in cost per quality-adjusted life-year (QALY) gained. RESULTS: From the perspective of the publicly funded healthcare system, full coverage resulted in greater quality-adjusted survival than the status quo (7.02 vs. 6.13 QALYs) but at increased cost ($20,423 vs. $17,173). The incremental cost-effectiveness ratio (ICER) for full coverage compared to the status quo was $3,663/QALY. This result was robust to a wide range of sensitivity analyses. In a secondary analysis from the perspective of government, the ICER for full coverage compared to the status quo was $12,350/QALY. In this analysis, the ICER was sensitive to changes in price elasticity, but remained below $50,000/QALY as long as the elasticity remained below -0.035. INTERPRETATION: Public payers in Canada should consider providing secondary prevention medications to myocardial infarctionpatients without private insurance free of charge. Full public coverage is cost-effective compared to the status quo.
Authors: Dennis T Ko; David A Alter; Peter C Austin; John J You; Douglas S Lee; Feng Qiu; Therese A Stukel; Jack V Tu Journal: Am Heart J Date: 2008-02 Impact factor: 4.749
Authors: Niteesh K Choudhry; Jerry Avorn; Elliott M Antman; Sebastian Schneeweiss; William H Shrank Journal: Health Aff (Millwood) Date: 2007 Jan-Feb Impact factor: 6.301
Authors: Philip S Wang; Amanda R Patrick; Colin R Dormuth; Jerry Avorn; Malcolm Maclure; Claire F Canning; Sebastian Schneeweiss Journal: Psychiatr Serv Date: 2008-04 Impact factor: 3.084
Authors: Marc A Pfeffer; John J V McMurray; Eric J Velazquez; Jean-Lucien Rouleau; Lars Køber; Aldo P Maggioni; Scott D Solomon; Karl Swedberg; Frans Van de Werf; Harvey White; Jeffrey D Leimberger; Marc Henis; Susan Edwards; Steven Zelenkofske; Mary Ann Sellers; Robert M Califf Journal: N Engl J Med Date: 2003-11-10 Impact factor: 91.245
Authors: Sebastian Schneeweiss; Amanda R Patrick; Malcolm Maclure; Colin R Dormuth; Robert J Glynn Journal: Circulation Date: 2007-04-09 Impact factor: 29.690
Authors: Alessandro Alberti; Pietro Giudice; Alessandra Gelera; Luca Stefanini; Virginia Priest; Michael Simmonds; Christa Lee; Matthew Wasserman Journal: Eur J Health Econ Date: 2015-02-11