AJMC: Providing discharge supply of antiplatelets saves money for payors
Nathan W. Carroll, MHA, from the department of health management and policy, and Michael P. Dorsch, PharmD, from the School of Public Health and department of pharmacy services, both at the University of Michigan Health System's College of Pharmacy in Ann Arbor, sought to propose a model in which insurers work with hospitals to provide a discharge supply of antiplatelet medication to patients receiving stents and to examine the cost implications of this strategy. Thus, they modeled a decision tree using data from previously published research.
The study adopted an insurer’s perspective.
The researchers took data on patient delays in filling antiplatelet prescriptions and rates of associated adverse events from published research. The costs of adverse events, including death or acute MI (AMI), were taken from Healthcare Cost and Utilization Project estimates of hospital costs for diagnosis-related groups associated with AMI.
In the base case, expected costs totaled $1,782 when stent implantation patients were provided with a discharge supply of medication and $1,857 under the current standard of care—a difference of $75. Insurers could supply up to 60 days of medication without increasing total costs. The strategy of offering a discharge supply of medication was cost saving under a range of estimated re-hospitalization costs and medication costs. However, this result was dependent on the ability of a discharge supply of medication to reduce rates of death or AMI.
This study modeled the expected costs for patients receiving standard therapy after stent implantation versus the costs associated with an alternative strategy in which patients were provided a discharge supply of medication. The model’s results suggested that offering a discharge supply of medication can reduce expected costs by $75 per patient in the base case.
In 2007, an estimated 1.18 million PCI procedures were performed in the U.S., and while not all PCI patients received a stent, the majority did. “Clearly, if the $75 per case expected savings were realized, the total savings would be significant,” the authors wrote. “Sensitivity analyses suggest that this result holds when estimates of re-hospitalization costs (for death and AMI) and medication costs are varied within reasonable ranges. However, this result is much less sensitive to variations in the rates of death or AMI assumed to prevail when patients are given a discharge supply of medication."
Based on their findings, Carroll and Dorsch concluded that managed care plans should consider waiving co-payments on antiplatelet medications for PCI patients and collaborating with hospitals to ensure that patients receive a supply of these medications upon discharge.
“Research has shown that failure to begin antiplatelet therapy promptly after PCI puts patients at increased risk for AMI or death, but many patients delay filling prescriptions for these medications,” the researchers summed. “In most of the scenarios modeled here, the expected costs of these complications to insurers exceed the cost of providing co-pay-free discharge supplies of medication to PCI patients.”