Abstract
BackgroundAcute myocardial infarction (AMI), a major source of morbidity and mortality, is also associated with excess costs. Findings from previous studies were divergent regarding the effect on health care expenditure of adherence to guideline-recommended medication. However, gender-specific medication effectiveness, correlating the effectiveness of concomitant medication and variation in adherence over time, has not yet been considered.MethodsWe aim to measure the effect of adherence on health care expenditures stratified by gender from a third-party payer’s perspective in a sample of statutory insured Disease Management Program participants over a follow-up period of 3-years. In 3627 AMI patients, the proportion of days covered (PDC) for four guideline-recommended medications was calculated. A generalized additive mixed model was used, taking into account inter-individual effects (mean PDC rate) and intra-individual effects (deviation from the mean PDC rate).ResultsRegarding inter-individual effects, for both sexes only anti-platelet agents had a significant negative influence indicating that higher mean PDC rates lead to higher costs. With respect to intra-individual effects, for females higher deviations from the mean PDC rate for angiotensin-converting enzyme (ACE) inhibitors, anti-platelet agents, and statins were associated with higher costs. Furthermore, for males, an increasing positive deviation from the PDC mean increases costs for β-blockers and a negative deviation decreases costs. For anti-platelet agents, an increasing deviation from the PDC-mean slightly increases costs.ConclusionPositive and negative deviation from the mean PDC rate, independent of how high the mean was, usually negatively affect health care expenditures. Therefore, continuity in intake of guideline-recommended medication is important to save costs.
Highlights
Recent decades have seen improvements in mortality and survival rates [1], cardiovascular disease (CVD) remains one of the leading causes of mortality and morbidity in industrialized countries [2]
We examined the association between health care expenditures and proportion of days covered (PDC) rates (PDC mean and PDC standard deviation) for anti-platelet agents, statins, β-blockers, and angiotensin-converting enzyme (ACE) inhibitors
Total health care expenditure The data set consisted of 4609 Disease Management Program (DMP) coronary artery disease (CAD) patients discharged from hospital with a diagnosis of Acute myocardial infarction (AMI), of which 4245 had a complete DMP documentation sheet in the last 180 days before AMI
Summary
Recent decades have seen improvements in mortality and survival rates [1], cardiovascular disease (CVD) remains one of the leading causes of mortality and morbidity in industrialized countries [2]. Acute myocardial infarction (AMI), a common manifestation of CVD in the elderly, carries increased risk of mortality, morbidity, and excess costs [3, 4]. In Germany, in 2016, 20,539 deaths in women and 28,130 deaths in men were caused by AMI, which reflected 49.2 and 69.3 deaths per 100,000 inhabitants in women and men respectively [5]. In the first year after AMI, cumulative total costs for AMI are about €13,061 per patient in Germany [6]. In the UK, between 0.4 and 1.0% of total health care expenditure was spent on AMI [8]. Acute myocardial infarction (AMI), a major source of morbidity and mortality, is associated with excess costs. Findings from previous studies were divergent regarding the effect on health care expenditure of adherence to guideline-recommended medication. Gender-specific medication effectiveness, correlating the effectiveness of concomitant medication and variation in adherence over time, has not yet been considered
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