|
E-mail this page to a friend!
New drug plan will reduce cost, but...
Free ACE Inhibitors for Seniors With Diabetes Would
Save Money for Medicare, Study Says
U. Michigan researchers say it would also save lives,
make life better
July 19, 2005 – ACE inhibitors should be available
free to the eight million American senior citizens over age 65 who have
diabetes, according to researchers at the University of Michigan Health
System. These drugs are so beneficial for these patients that even
giving them away ultimately would save the Medicare system and society
large amounts of money by preventing heart attacks, strokes and kidney
failure, the study shows.
And, of course, the drugs would save lives, and
make life better for patients, note the researchers, whose findings are
based on a sophisticated computer analysis. The study is reported in the
today’s Annals of Internal Medicine.
Right now, cost or lack of awareness keeps many
older diabetes patients from taking ACE inhibitors, which reduce blood
pressure and cut the risk of diabetes-related problems in the
cardiovascular system and kidneys. In fact, fewer than half of patients
who should take them actually do take them, according to a report on the
study written by Kara Gavin.
The new study is especially timely because for the
first time ever, Medicare soon will begin covering part of the cost of
prescription drugs for people over age 65. That should increase the use
of ACE inhibitors by seniors with diabetes, as their out-of-pocket cost
for the drug declines.
But under the new Medicare plan, seniors will still
pay for part of their drug costs in the form of premiums, deductibles
and co-pays — and research has shown that even small out-of-pocket costs
keep many people from taking drugs that can help them.
Says lead author Allison Rosen, M.D., M.P.H., Sc.D.,
“Patients’ out-of-pocket costs such as co-pays are a blunt instrument
designed to keep patients from over-using medications, but they create
barriers to the use of essential and non-essential medications alike.
Our analysis shows that removing all patient costs for diabetes patients
taking ACE inhibitors could save Medicare both lives and money.”
The same may be true for other drugs that have a
major preventive benefit, she says; future studies will assess what
would happen if patients could get them free or at a reduced cost.
That principle, called the “benefit-based co-pay,”
is gaining more attention in the insurance field as a more sophisticated
way to structure prescription drug benefits. But Medicare’s new drug
plan currently doesn’t provide for the approach.
The benefit-based co-pay was first proposed in 2001
by Mark Fendrick, M.D., a co-author on the new paper and professor of
internal medicine at the U-M Medical School. Rosen, an assistant
professor of internal medicine at U-M who performed the newly published
research in part while at Harvard University, explores drug costs and
benefits though computer models. She worked with Sandeep Vijan, M.D.,
M.S., of U-M and the VA Ann Arbor Healthcare Center, on the new paper.
The new finding is based on a model that takes into
account the substantial known health benefits of ACE inhibitors, the
rates and costs of diabetes-related complications among people over the
age of 65, the current and projected costs and use of ACE inhibitors by
older people with diabetes, and the impact of even modest cash payments
on patients’ prescription-filling behavior.
ACE inhibitors have been shown to slow the damage
to the kidneys that is often experienced by people with diabetes, and
prevent them from entering end-stage renal failure (ESRD) in which the
kidneys essentially shut down and patients need dialysis. ACE inhibitors
have also been shown to cut the extra-high risk of heart attacks and
strokes faced by people with diabetes; around 60 percent of people with
diabetes die of a cardiovascular problem.
“There are many drugs that are effective, but few
that are this dramatically effective,” says Vijan. “Our analyses suggest
that co-payments for ACE inhibitors may actually cost Medicare and other
insurers more money by providing barriers to use of these drugs. It is
sound policy, both from a patient perspective and from a fiscal
perspective, to analyze drug co-payments on a case-by-case basis.”
“All in all, ACE inhibitors are widely recommended
as important medications for almost anyone with diabetes to take,” says
Rosen. “But cost has been shown to get in the way. And so, the Medicare
program — and all American taxpayers — are paying instead for the
hospital bills of people who had heart attacks and strokes that might
have been prevented if they’d been taking ACE inhibitors.”
The researchers assumed that if Medicare made ACE
inhibitors available for free to any enrollee with diabetes, the use of
the drugs would increase from 40 percent of patients to 60 percent of
patients. Based on research into the effect of co-pays on patient
behavior, they projected that the new Medicare drug plan, which will
cover about one-third of the cost of the drug, will increase usage from
40 percent to about 47 percent.
The researchers based their model on the drug
called lisinopril, a generic ACE inhibitor sold as Zestril or Prinivil
that costs around $200 to $300 per year, though bulk purchasers such as
the Department of Defense health care system pay much less. The new
Medicare drug plan will not negotiate prices on a national level because
of a clause in the law that establishes it.
If Medicare paid for the cost of the drug for all
adults over age 65 who have diabetes, added to the existing cost of all
their healthcare until death, the total savings would be $1,606 over a
lifetime for each Medicare recipient. The patients would also live
longer and better; the researchers calculated that the approach could
save one-quarter of a quality-adjusted life year (QALY) for each
patient. QALY is a measure of both time lived and the quality of life
during that time; for example, someone who was disabled by a stroke has
a lower QALY than someone who has never had a stroke.
“In our society, we often pay for health strategies
that provide health benefits at a reasonable but added cost,” says
Rosen. “But this strategy goes even further: it saves lives and saves
money. Removing patient financial barriers for ACE inhibitors prevents
expensive and life-threatening complications, and improves quality of
life. In so doing, patients pay less, Medicare pays less, and everyone
wins. It’s a virtual no-brainer.”
Even if the availability of free ACE inhibitors
didn’t cause a major upswing in the use of the drugs by these patients,
the strategy would still pay for itself, Rosen says.
“If only 7 percent more people started taking ACE
inhibitors when they were offered at no cost, Medicare would still save
money. The more people that take advantage of the no-cost drugs, the
bigger the savings for Medicare over the long term. And of course, each
patient has a lower risk of heart attack, stroke, or kidney failure.”
The researchers ran the computer model many times,
making changes each time in 38 different variables. Ninety percent of
the time, they found that no-cost ACE inhibitors saved money; the other
10 percent of the time they were cost-effective — costing less than
$20,000 per QALY gained.
The authors also looked at costs and savings on a
societal, rather than Medicare, level — including patients’ productivity
and the cost of caregiving for people with health-related disability.
The savings were even greater than Medicare savings alone.
If Medicare were able to purchase ACE inhibitors
for all its diabetes patients at the same low cost that the Department
of Defense pays, the government’s lifetime savings on each patient would
be even higher. And it would only take a 1.1 percent increase in patient
use of ACE inhibitors to make the program cost-saving.
Rosen notes that the analysis doesn’t even take
into account more recent evidence that ACE inhibitors can also help
people with diabetes prevent nerve damage that can cost them their
ability to walk, and eye damage that can leave them blind. Neither did
it look at ACE inhibitors’ role in preventing heart failure among
elderly diabetes patients.
In addition to Rosen, Fendrick and Vijan, the
authors of the new paper include Harvard University researchers Mary
Beth Hamel, M.D., Milton C. Weinstein, Ph.D., and David M. Cutler, Ph.D.
The research was funded in part by the Primary Care Research Fund of the
Brigham & Women’s Hospital. Reference: Annals of Internal Medicine, July
19, 2005, Vol. 143, No. 2.
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
