ORLANDO, FLA. ― Heart attack patients who got free medications had lower rates of rehospitalization for heart attack or heart failure compared to patients who had prescription co-pays, however, they did not have a reduction in the rate of revascularization to reopen clogged arteries, according to late-breaking research presented at the American Heart Association’s Scientific Sessions 2011.
The Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) Trial is also published in The New England Journal of Medicine.
After a heart attack, patients are often sent home with several prescriptions to prevent further heart problems. However, many don’t take their medications as prescribed, researchers said.
In this study of 5,855 heart attack patients, 2,845 paid nothing for their cholesterol-lowering and other medications shown to improve patient outcomes after a heart attack. Those patients were 4 percent to 6 percent more likely to take them than the 3,010 who had co-pays.
Researchers found that 17.6 percent of those with free medications had a major cardiac event (heart attack, angina, stroke or heart failure) or underwent revascularization, compared to 18.8 percent of those with co-pays. This difference was not statistically significant, but when assessed separately from revascularization, there was a significant reduction in the rate of major cardiac events. After about a year, the rate of heart attacks, angina and heart failure dropped 14 percent in the patients getting free medications.
Furthermore, patients saved 26 percent on their overall out-of-pocket healthcare costs. Because they had improved health, they paid fewer copayments for doctor’s visits in addition to the savings from no drug co-pays, researchers said.
The insurance company’s costs did not increase. While insurers spent more on medications, they spent less on treating subsequent heart problems.
“Medication adherence is very low and that’s a major public health problem,” said Niteesh K. Choudhry, M.D., Ph.D., the study’s lead researcher, associate professor at Harvard University and associate physician at Brigham and Women’s Hospital in Boston, Mass. “There are many reasons why only half of patients adhere to long-term therapies and cost appears to be one reason, even for those with insurance.”
He said, based on the study’s results, he recommends insurers consider paying for the total cost of heart medications after a heart attack.
“The strategy we evaluated improves quality of care, increases medication adherence, makes healthcare more affordable for patients and doesn’t appear to increase overall spending, and so appears very attractive for patients and payers,” he said. “We have spent billions of dollars developing medicines and testing them. Making sure patients actually take those medicines is crucial.”
Co-authors are Jerry Avorn, M.D.; Robert J. Glynn, Sc.D., Ph.D.; Elliott M. Antman, M.D.; Sebastian Schneeweiss, M.D., Sc.D.; Michele Toscano, M.S.; Lonny Reisman, M.D.; Joaquim Fernandes, M.S.; Claire Spettell, Ph.D.; Joy L. Lee, M.S.; Raisa Levin, M.S.; Troyen Brennan, M.D., J.D, M.P.H.; and William H. Shrank, M.D., M.S.H.S.
Disclosures are here: http://newsroom.heart.org/pr/aha/document/Disclosures_for_LBCT.xlsx.
Aetna, a national insurance company, funded and provided the medications for this study. The Commonwealth Fund also funded the study.
Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding .
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