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Study Examines Burden of Cardiovascular Disease From Managed Care Perspective

Costs reduced when PPI used with aspirin (Apr. 5)

Researchers have looked at the burden of secondary cardiovascular disease in commercial and Medicare patients from a managed care perspective. Their findings were presented April 4 at the Academy of Managed Care Pharmacy’s 25th Annual Meeting & Expo in San Diego, California.

The secondary prevention of cardiovascular events includes the daily use of aspirin. Chronic aspirin therapy, however, is associated with significant gastrointestinal (GI) toxicity, including dyspepsia, gastric ulcers, and GI bleeding, all of which contribute to the disease and cost burdens of secondary prevention. The GI toxicity of aspirin can be mitigated by the use of proton pump inhibitors (PPIs).

The new analysis demonstrated that the prevention of cardiovascular events with aspirin plus a PPI compared with aspirin alone is associated with a net per-patient per-year cost decrease of $103 and $145 and a potential overall cost decrease of $1.8 million and $11.0 million for a typical 1 million-member commercial and Medicare plan, respectively.

“The overall cost of secondary cardiovascular events in patients with a history of coronary heart disease, transient ischemic attack, or ischemic stroke represents a significant financial burden on managed care,” said Rashad Carlton, PharmD, MSPH. “Despite American College of Cardiology and American Heart Association guideline recommendations to start aspirin therapy and continue indefinitely in all patients unless contraindicated, aspirin remains underutilized.”

The primary objective of the new study was to characterize the financial burden of secondary cardiovascular disease and its long-term complications in patients at risk for a secondary cardiovascular event.

An economic model designed to yield the annual secondary cardiovascular disease cost burden was constructed using literature-based population, medication discontinuation or nonadherence, and cardiovascular-event incidence data. Care records of patients with secondary cardiovascular disease were reviewed based on treatment with aspirin, aspirin plus a PPI, or no aspirin. Secondary events were calculated based on annual recurrence rates adjusted for treatment discontinuation or nonadherence. The treatment cohort per-member cost and total cost, along with the overall annual expense to the plan of secondary cardiovascular disease, were determined based on AWP/MAC drug pricing and published discharge data for cardiovascular and GI events.

The investigators found that a typical commercial plan with 1 million lives has an estimated 68,276 members who are considered to have secondary cardiovascular disease (26,753 who have experienced a stroke or transient ischemic attack [TIA], and 41,523 who have coronary heart disease [CHD]). A typical Medicare population with 1 million lives has an estimated 295,711 members who have had secondary cardiovascular disease (124,451 stroke or TIA members, and 171,260 CHD members). Of those members with secondary cardiovascular disease, 71% take aspirin therapy (26% use aspirin alone and 45% use aspirin plus a PPI), and 15% do not. The remaining 14% of patients who use an antiplatelet other than aspirin, with or without an anticoagulant, were excluded from the analysis.

Source: Pozen; April 5, 2013.

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