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Article
Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes
Quantitative Health Sciences Publications and Presentations
  • Allison B. Rosen, University of Massachusetts Medical School
  • Mary Beth Hamel, Beth Israel Deaconess Medical Center
  • Milton C. Weinstein, Harvard School of Public Health
  • David M. Cutler, Harvard University
  • A. Mark Fendrick, University of Michigan Health Systems
  • Sandeep Vijan, Ann Arbor Veterans Affairs Medical Center
UMMS Affiliation
Department of Quantitative Health Sciences
Date
7-20-2005
Document Type
Article
Medical Subject Headings
Aged; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Diseases; Cost-Benefit Analysis; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Diabetic Nephropathies; Disease Progression; Drug Costs; Humans; Markov Chains; Medicare; Patient Compliance; Quality-Adjusted Life Years; Sensitivity and Specificity; United States
Abstract
BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors slow renal disease progression and reduce cardiac morbidity and mortality in patients with diabetes. Patients' out-of-pocket costs pose a barrier to using this effective therapy. OBJECTIVE: To estimate the cost-effectiveness to Medicare of first-dollar coverage (no cost sharing) of ACE inhibitors for beneficiaries with diabetes. DESIGN: Markov model with costs and benefits discounted at 3%. DATA SOURCES: Published literature and Medicare claims data. TARGET POPULATION: 65-year-old Medicare beneficiary with diabetes. TIME HORIZON: Lifetime. PERSPECTIVE: Medicare and societal. INTERVENTIONS: We evaluated Medicare first-dollar coverage of ACE inhibitors compared with current practice (no coverage) and the new Medicare drug benefit. OUTCOME MEASURES: Costs (2003 U.S. dollars), quality-adjusted life-years (QALYs), life-years, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: Compared with current practice, first-dollar coverage of ACE inhibitors saved both lives and money (0.23 QALYs gained and 1606 USD saved per Medicare beneficiary). Compared with the new Medicare drug benefit, first-dollar coverage remained a dominant strategy (0.15 QALYs gained, 922 USD saved). RESULTS OF SENSITIVITY ANALYSIS: Results were most sensitive to our estimate of increase in ACE inhibitor use; however, if ACE inhibitor use increased by only 7.2% (from 40% to 47.2%), first-dollar coverage would remain life-saving at no net cost to Medicare. In analyses conducted from the societal perspective, benefits were similar and cost savings were larger. LIMITATIONS: Results depend on accuracy of the underlying data and assumptions. The effect of more generous drug coverage on medication adherence is uncertain. CONCLUSIONS: Medicare first-dollar coverage of ACE inhibitors for beneficiaries with diabetes appears to extend life and reduce Medicare program costs. A reduction in program costs may result in more money to spend on other health care needs of the elderly.
Rights and Permissions
Citation: Ann Intern Med. 2005 Jul 19;143(2):89-99.
Related Resources
Link to Article in PubMed
Citation Information
Allison B. Rosen, Mary Beth Hamel, Milton C. Weinstein, David M. Cutler, et al.. "Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes" Vol. 143 Iss. 2 (2005) ISSN: 0003-4819 (Linking)
Available at: http://works.bepress.com/allison_rosen/35/