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Adhering to Cardiovascular Medication Guidelines Saves Lives, Lowers Costs
Patients with myocardial infarction (MI) and atherosclerotic disease (ATH), who adhere to the guideline-recommended therapies experienced a lower rate of major adverse cardiovascular events (MACE) and had reduced their annual medical costs, according to a recent study published in the Journal of the American College of Cardiology.
In order to determine the association between medication adherence levels and long-term MACE in patents with MI and ATH, the researchers queried the claims databases of a large health insurer. Their primary outcome measure was a composite of all-cause death, MI, stroke, or coronary revascularization. Using proportion of days covered for statins and angiotensin-converting enzyme inhibitors, patients were divided into three groups including fully adherent, who were at least 80% adherent; partially adherent patients, who were less than 80% but at least 40% adherent; and non-adherent, those less than 40% adherent. Researchers estimated per-patient annual direct medical (ADM) costs by using unit costs from two national files.
Data claims which were analyzed included 4,015 post-MI patients and 12,976 patients with ATH. In the post-MI patient group, fully adherent patients had a significantly lower MACE than the non-adherent patient group (P = .0004), and results for the partially adherent, post-MI patients, were similar (P = .02), all at two years.
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Comparatively, the ATH fully adherent group had a significantly lower rate of MACE than the non-adherent (P < .0001) and the partially adherent (P < .0001) groups at 2 years.
The researchers also noted the significant cost savings associated with cardiovascular adherence.
“The total costs of CV disease in 2010 were estimated to be $444 billion, representing approximately 17% of overall national health expenditures,” Sameer Bansilal, MD, MS, lead study author and assistant professor of medicine at the Icahn School of Medicine at Mount Sinai School in New York, and colleagues wrote. “In the present study, we estimated per person cost differences between the adherence groups.”
Study findings showed that fully adherent patients saved hundreds in annual medical costs. The MI patient group saved $369 and $400 per patient, compared to the partially adherent and non-adherent groups. Additionally, fully adherent patients in the atherosclerosis cohort saved $371 and $907 annually, per patient, compared to both less adherent groups.
The researchers suggested that novel approaches to improve adherence may reduce cardiovascular events. They also identified the suggested optimal threshold of adherence required to effectively reduce risks.
“There seemed to be a threshold effect for this benefit at more than 80% adherence in the post-MI population; at least 40% levels of adherence need to be maintained in the long term to continue to accrue benefit,” they wrote. --Julie Gould
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