Elderly/Long-term Care

Increased use of ACE inhibitors for elderly people with diabetes could improve outcomes and save money

Diabetes is a major cause of end-stage renal disease and cardiovascular disease in the United States. Angiotensin-converting enzyme (ACE) inhibitors can effectively reduce these diabetes complications. However, these medications are often underused because elderly people with diabetes may cut back on their drug use due to prescription copayments.

The Medicare program could improve clinical outcomes and save money by providing full coverage of ACE inhibitors with no out-of-pocket expense for patients with diabetes. Medicare would reap clinical and economic benefits even if full coverage only resulted in a modest 7.2 percent increase in ACE inhibitor use, concludes a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00020).

Researchers used published study results and Medicare claims data to develop a model to estimate the cost-effectiveness of first-dollar coverage (no cost sharing) of ACE inhibitors for elderly Medicare beneficiaries with diabetes. When compared with the current practice of no coverage of ACE inhibitors, providing first-dollar coverage saved both lives and money (0.23 quality-adjusted life years gained and $1,606 saved per Medicare beneficiary).

More details are in "Cost-effectiveness of full Medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes," by Allison B. Rosen, M.D., M.P.H., Mary Beth Hamel, M.D., M.P.H., Milton C. Weinstein, Ph.D., and others, in the July 2005 Annals of Internal Medicine 143(2), pp. 89-99.

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