Making headway, maybe

Talk about mixed results. It has been a week of conflicting news in the cardiovascular world.

First, the good news. An analysis of national survey data that spanned 22 years found blood cholesterol trends in the U.S. pointing in the desired direction. Levels of total cholesterol, low-density lipoprotein cholesterol and non-high-density lipoprotein all dropped across most adult populations in the U.S., according to the study, which was published Oct. 17 in the Journal of the American Medical Association.   

The study’s findings suggest that we’ve made progress at reducing these cardiovascular risk factors. But among nuggets in a recently released evaluation of CathPCI registry data, researchers reported that 80 percent of patients who underwent angioplasty or PCI had dyslipidemia. About 80 percent also were overweight, and 45 percent were obese. These and many other results appeared online Oct. 17 in the Journal of the American College of Cardiology.

Moving to measures of another sort, two studies on lowering or eliminating copayments for cardiovascular medications offered positive and neutral results. John F. Hoadley, PhD, at Georgetown University Health Policy Institute in Washington, D.C., and colleagues looked at the different drug plan benefits and how they influenced patient use of lower cost generic statins. The patient population in this case was Medicare Part D enrollees. They showed predicted rates of generic statin use ranged from 51 percent to 88 percent, with that latter based on zero copays for generics.

They estimated that every 10 percent increase in the use of a generic would save Medicare $1 billion annually. Their study was published in the October issue of Health Affairs.

Niteesh K. Choudhry, MD, PhD, of Brigham and Women’s Hospital in Boston, and colleagues posed a similar policy-related question. They explored the impact of lowering copayments for statins and clopidogrel, based on a policy change introduced in 2007 by Pitney Bowes. The company reduced copayments for statins for patients being treated for vascular disease or diabetes and for clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis) for all patients prescribed the medication.

From the patient and physician perspective, the program was a smash, according to results published online Oct. 3 in the Journal of the American College of Cardiology. Patient costs plummeted and adherence rates rose in the reduced copay groups compared with the control groups. The reduced copay groups also had lower rates of physician visits, hospitalizations and emergency department admissions but not of major coronary events or coronary revascularization.

The insurer’s combined pharmacy and medical spending rose while patient out-of-pocket costs dropped, making the program cost neutral. Neutral is not bad. It should be noted that the analysis covered only one year, and one year may be too soon to reap the full cost-saving benefits of medication adherence.

On another note, please be sure to check our website and newsletters next week as we cover the late-breaking clinical trials and other events that the Transcatheter Cardiovascular Therapeutics (TCT) conference in Miami. We expect to have many new findings to share.

Candace Stuart