The impact of reducing cardiovascular medication copayments on health spending and resource utilization.
J Am Coll Cardiol
; 60(18): 1817-24, 2012 Oct 30.
Article
em En
| MEDLINE
| ID: mdl-23040581
ABSTRACT
OBJECTIVES:
The aim of this study was to evaluate the impact of reductions in statin and clopidogrel copayments on cardiovascular resource utilization, major coronary events, and insurer spending.BACKGROUND:
Copayments are widely used to contain health spending but cause patients to reduce their use of essential cardiovascular medications. Reducing copayments for post-myocardial infarction secondary prevention has beneficial effects, but the impact of this strategy for lower risk patients and other drugs remains unclear.METHODS:
An evaluation was conducted of health care spending and resource use by a large self-insured employer that reduced statin copayments for patients with diabetes or vascular disease and reduced clopidogrel copayments for all patients prescribed this drug. Eligible individuals in the intervention company (n = 3,513) were compared with a control group from other companies without such a policy (n = 49,803). Analyses were performed using segmented regression models with generalized estimating equations.RESULTS:
Lowering copayments was associated with significant reductions in rates of physician visits (relative change statin users 0.80; 95% confidence interval [CI] 0.57 to 0.98; clopidogrel users 0.87; 95% CI 0.59 to 0.96) and hospitalizations and emergency department admissions (relative change statin users 0.90; 95% CI 0.80 to 0.92; clopidogrel users 0.89; 95% CI 0.74 to 0.90) although not major coronary events. Patient out-of-pocket spending for drugs and other medical services decreased (relative change statin users 0.79; 95% CI 0.75 to 0.83; clopidogrel users 0.74; 95% CI 0.66 to 0.82). Providing more generous coverage did not increase overall spending (relative change statin users 1.03; 95% CI 0.97 to 1.09; clopidogrel users 0.94; 95% CI 0.87 to 1.03).CONCLUSIONS:
Lowering copayments for statins and clopidogrel was associated with reductions in health care resource use and patient out-of-pocket spending. The policy appeared cost neutral with respect to overall health spending.
Texto completo:
1
Temas:
ECOS
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Aspectos_gerais
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Estado_mercado_regulacao
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Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Doenças Cardiovasculares
Tipo de estudo:
Etiology_studies
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Observational_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Am Coll Cardiol
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Estados Unidos