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Ann Intern Med. 2005 Jul 19;143(2):89-99.

Cost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes.

Author information

  • 1Division of General Medicine, University of Michigan Health Systems, 300 North Ingalls, Suite 7E10, Ann Arbor, MI 48109, USA. abrosen@umich.edu

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.

Comment in

PMID:
16027450
[PubMed - indexed for MEDLINE]
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