Acute Care/Hospitalization

Providing combination medication for elderly patients following a heart attack can save both lives and money

When taken in combination after a heart attack, aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and statins are estimated to reduce risk of dying from coronary heart disease by 80 percent compared with placebo. These medications continue to be greatly underused, even among patients with coverage for prescription drugs.

Out-of-pocket costs for the medications are a key barrier to elderly patients taking them, note Harvard Medical School researchers. They estimated that providing combination drug therapy without cost sharing (full drug prescription coverage) to the 423,000 Americans with drug insurance who suffer their first heart attack would save 4,736 lives and would save insurers $5,974 per patient.

The researchers developed a model to estimate anticipated changes in coronary event rates and health care spending if combination drug therapy were provided without any out-of-pocket costs to patients 65 years and older with some drug coverage who were discharged after hospitalization for a heart attack. They conducted the analysis from the perspective of a typical insurer that provides coverage for both medications and medical care. To assess the potential benefit of full coverage, they observed post-heart attack rates of death, reinfarction, nonfatal stroke, readmission for congestive heart failure, and medication adherence.

Under base-case assumptions, full coverage was expected to increase compliance with combination drug therapy from 50 percent to 76 percent. For every 100 post-heart attack patients, this would result in 1.1 fewer deaths, 13.1 fewer nonfatal heart attacks, 1.2 fewer nonfatal strokes, and 6.6 fewer readmissions for heart failure than with current coverage.

Expanded coverage would cost insurers an average of $644 more per patient, but would avert $6,770 in coronary event-related costs on average. Therefore, insurers would save $5,974 per patient, a substantial savings.

The study was supported by the Agency for Healthcare Research and Quality (HS10881).

See "Should patients receive secondary prevention medications for free after a myocardial infarction? An economic analysis," by Niteesh K. Choudhry, M.D., Ph.D., Jerry Avorn, M.D., Elliott M. Antman, M.D., and others, in the January/February 2007 Health Affairs 26(1), pp. 186-194.

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