Comparative Cost-Effectiveness of Interventions to Improve Medication Adherence after Myocardial Infarction

Authors

  • Kouta Ito M.D., M.S.,

    1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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  • William H. Shrank M.D., M.S.H.S.,

    1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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  • Jerry Avorn M.D.,

    1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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  • Amanda R. Patrick M.S.,,

    1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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  • Troyen A. Brennan M.D., M.P.H.,,

    1. CVS Caremark, Woonsocket, RI
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  • Elliot M. Antman M.D.,,

    1. Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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  • Niteesh K. Choudhry M.D., Ph.D.

    Corresponding author
    • Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Author correspondence to Niteesh K. Choudhry, M.D., Ph.D., Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120; e-mail: nchoudhry@partners.org

Abstract

Objective

To evaluate the comparative cost-effectiveness of interventions to improve adherence to evidence-based medications among postmyocardial infarction (MI) patients.

Data Sources/Study Setting

Cost-effectiveness analysis.

Study Design

We developed a Markov model simulating a hypothetical cohort of 65-year-old post-MI patients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained.

Data Collection/Extraction Methods

Model inputs were extracted from published literature.

Principal Findings

Compared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were $74,600, $69,200, $133,000, $113,000, and $142,900 per QALY gained, respectively. In an incremental analysis, only mailed education had an ICER of less than $100,000 per QALY and was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than $100 per month.

Conclusions

Mailed education and a polypill, once available, may be the cost-saving strategies for improving post-MI medication adherence.

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