Breaking News
October 22, 2018 - The International Society of Refractive Surgery honors Vivior Chairman with Casebeer Award
October 22, 2018 - Multi-strain probiotic helps reduce chemotherapy-induced diarrhea in cancer patients
October 22, 2018 - Study shows potential of avelumab plus axitinib as new treatment option for patients with advanced RCC
October 22, 2018 - Vertex gets European CHMP positive opinion for KALYDECO to treat patients with cystic fibrosis
October 22, 2018 - Phase III trial reports positive results with HDAC inhibitor in advanced breast cancer patients
October 22, 2018 - Prostate radiotherapy improves survival in men with low burden of metastatic disease
October 22, 2018 - Free phone app helps low-income obese patients to lose weight
October 22, 2018 - Compression Collar May Protect Brain of Female Soccer Players
October 22, 2018 - Technique visualizes neuron communication
October 22, 2018 - Advancement in medical imaging methods for health care
October 22, 2018 - Takeda presents vedolizumab phase 3 VISIBLE 1 trial results for treatment of moderately to severely active ulcerative colitis
October 22, 2018 - Immunotherapy increases survival in some patients with metastatic triple negative breast cancer
October 22, 2018 - Exelixis presents CABOSUN and METEOR trial results in patients with advanced renal cell carcinoma
October 22, 2018 - LYNPARZA Phase III SOLO-1 results show improved outcome for patients with advanced BRCA-mutated ovarian cancer
October 22, 2018 - Brainlab unveils ExacTrac Dynamic at ASTRO meeting in San Antonio, Texas
October 22, 2018 - Not exercising is worse than smoking, diabetes or heart disease finds study
October 22, 2018 - Shorter course of trastuzumab could be an option for women with HER2+ early breast cancer
October 22, 2018 - Map of Mouse Hippocampus Could Be Weapon Against Alzheimer’s
October 22, 2018 - Psychotropic polypharmacy is common in Alzheimer’s disease
October 22, 2018 - Texas A&M and UTA establish Texas Genomics Core Alliance
October 22, 2018 - Analyzing mouse’s potential as animal model of decision-making
October 22, 2018 - Radiotherapy can prolong survival in prostate cancer
October 22, 2018 - A genetic mutation involved in relapse
October 21, 2018 - Report reveals growing impact of cannabis on young people
October 21, 2018 - NSF awards $5 million grant to help scientists magnify societal impact of research
October 21, 2018 - Fertility Rates Down for Each Urbanization Level 2007 to 2017
October 21, 2018 - Genetically engineered 3-D human muscle transplant in a murine model
October 21, 2018 - Moms’ tight work schedules may affect their children’s sleep
October 21, 2018 - AHA: No Direct Link Between Preeclampsia and Cognitive Impairment, Study Finds
October 21, 2018 - Weight loss success linked with active self-control regions of the brain
October 21, 2018 - Scripps researchers successfully test potential new smoking-cessation treatment in rodents
October 21, 2018 - More accurate and less stressful way to measure a baby’s heartbeat
October 21, 2018 - Researchers show better cardiorespiratory fitness leads to longer life
October 21, 2018 - Healthy candies for diabetic patients
October 21, 2018 - Environment impact of microplastics remains unclear
October 21, 2018 - Antibiotics for appendicitis? Surgery often not needed
October 21, 2018 - AHA and AMA recognize more than 800 medical practices, health systems for blood pressure control
October 21, 2018 - Scientists obtain clearest ever image of Ebola virus protein
October 21, 2018 - Study reveals connection between two proteins known to be hyperactive in cancer
October 21, 2018 - Gabapentin Beats Pregabalin for Chronic Sciatica
October 21, 2018 - Cosmetic surgeons offering incomplete information for breast augmentation customers
October 21, 2018 - Chronic sleep disruption in early adult life accelerates AD-related tau pathology
October 21, 2018 - Take 10 for Mindfulness – Drugs.com MedNews
October 21, 2018 - Length of breathing disruption in OSA may be better predictor of mortality risk
October 21, 2018 - ApoE4 gene linked with chronic inflammation increases risk for Alzheimer’s disease
October 21, 2018 - Mother-daughter conflict associated with suicide risk in abused adolescent girls
October 21, 2018 - Scientists molding bacteria into unnatural shapes
October 21, 2018 - High diet quality associated with lower risk of death in colorectal cancer patients
October 21, 2018 - Discharged mental health patients ‘at greater risk of dying’
October 21, 2018 - Research provides insight into neurobiology of aggression and bullying
October 21, 2018 - As billions in tax dollars flow to private Medicaid plans, Who’s minding the store?
October 21, 2018 - Neuroscientists identify brain region that appears to be related to food preference decisions
October 21, 2018 - Deaths related to air pollution in the U.S. decreased by 47% between 1990 and 2010
October 21, 2018 - Study shows correlation between spatial memory and the sense of smell
October 21, 2018 - Increased cardiorespiratory fitness associated with reduced long-term mortality
October 21, 2018 - IU researchers receive $1.55 million from NIH to improve chronic-disease management
October 21, 2018 - Income and wealth affect the mental health of Australians, study shows
October 21, 2018 - Patients with hypertension and psoriasis more often require cardiovascular interventions
October 20, 2018 - Leading hip-hop videos depict use of tobacco and marijuana products, study finds
October 20, 2018 - Dose Range of IV Ketamine for Adjunct Tx of Depression Tested
October 20, 2018 - Infants can distinguish between leaders and bullies, study finds
October 20, 2018 - Mad Cow disease found on Aberdeenshire farm
October 20, 2018 - Study identifies factors associated with prescription opioid misuse among students
October 20, 2018 - Scientists uncover key regulator of mTORC1 in cancer growth
October 20, 2018 - Pounds Regained After Weight-Loss Op Can Tell Your Doc a Lot
October 20, 2018 - Sending parents letters to fight childhood obesity doesn’t work
October 20, 2018 - Supervised aerobic exercise can support major depression treatment
October 20, 2018 - Mindfulness-based program effective for reducing stress in infertile women
October 20, 2018 - Molecule capable of halting and reverting neurodegeneration caused by Parkinson’s disease identified
October 20, 2018 - Midazolam-mediated alterations of PER2 expression may have functional consequences during myocardial ischemia
October 20, 2018 - Sweat bees are ideal for studying the genes underlying social behavior
October 20, 2018 - Weight loss success associated with brain areas involved in self-control
October 20, 2018 - KHN’s ‘What the Health?’ Republicans’ preexisting political problem
October 20, 2018 - Research provides a more complete picture of suffering caused by terrorist attacks
October 20, 2018 - Eradicating Helicobacter pylori infections may be a key treatment for Parkinson’s disease
October 20, 2018 - Breast Cancer as a Dynamic Disease
October 20, 2018 - University of Pittsburgh wins NSF grant for big data research to prevent complications from anesthesia
October 20, 2018 - Skin-to-skin contact may promote attachment between parents and preterm infants
October 20, 2018 - Recommendations Developed to Verify NGT Placement in Children
October 20, 2018 - Weight loss can be boosted fivefold thanks to novel mental imagery technique
Reducing co-payments improves patient, physician adherence to guideline-recommended treatment post-MI

Reducing co-payments improves patient, physician adherence to guideline-recommended treatment post-MI

image_pdfDownload PDFimage_print

When patients who had a heart attack were given vouchers to cover their co-payments for medication to prevent a recurrence, physicians were more likely to prescribe a more effective, branded drug and patients were more likely to continue taking the medication for a full year as recommended in treatment guidelines, researchers reported at the American College of Cardiology’s 67th Annual Scientific Session.

“The study met its primary endpoint of improving adherence to guideline-recommended therapy at one year,” said Tracy Wang, MD, MHS, MSc, associate professor of medicine at Duke University Medical School and lead author of the study. “When affordability was not an issue, physicians felt less restrained in their ability to choose medications, and patients were 16 percent less likely to prematurely stop taking the medication.”

The study found no significant differences between patient groups for the study’s co-primary endpoint, the combined rate of heart attack, stroke or death from any cause, Wang said.

Current guidelines recommend use of antiplatelet medication—specifically, drugs such as clopidogrel or ticagrelor—for at least a year following a heart attack. Previous studies suggested, however, that adherence to this treatment regimen begins to drop off after a few months, and by one year more than one-third of patients are no longer taking their medication. Other studies have suggested that cost is a major reason that some patients stop taking prescribed medications. At least one previous study showed that treatment adherence improved when patients received their medications at no charge.

The current study, known as ARTEMIS, is the first large, prospective, multicenter trial to examine how co-payment vouchers affect patient adherence to recommended medical therapy, Wang said.

The trial enrolled 11,001 patients treated for a heart attack at one of 301 U.S. hospitals. All patients had health insurance; 64 percent had private insurance, 42 percent were on Medicare and 9 percent were on Medicaid. Seventeen percent reported previously not filling a prescription because of the medication’s cost.

Participating hospitals were randomly assigned to either the intervention or usual-care arm of the study. At all participating hospitals, doctors used their clinical judgment to decide whether to prescribe clopidogrel or ticagrelor for each patient. At the intervention hospitals, but not at the usual-care hospitals, patients received vouchers that waived the co-pay for their prescribed antiplatelet medication for one year.

Although clopidogrel is available as a generic medication, the newer and more potent antiplatelet agent ticagrelor is currently available only as a branded product. Many patients have higher out-of-pocket costs for the same supply of a brand-name drug versus the generic version.

The study’s co-primary endpoints were continued use of the prescribed antiplatelet drug at one year without a gap in use of 30 days or more and the combined rate of heart attack, stroke or death from any cause.

Because previous studies suggested that patients may report higher rates of treatment adherence than they actually achieve, the researchers validated patient reports by analyzing pharmacy records of the prescriptions filled by 8,360 patients and by periodically testing for blood levels of the medication in a subset of 944 patients.

Among patients who received vouchers, 87 percent reported taking their medication as prescribed, compared with 84 percent of the patients who received usual care. By contrast, the analysis of pharmacy records showed an adherence rate of 55 percent for the patients receiving vouchers compared with 46 percent for those receiving usual care. In the subset of patients who had their blood tested, 92 percent in the voucher group were adherent compared with 88 percent in the usual-care group. All of these differences were statistically significant, Wang said.

“While we know that patients often over-estimate their own adherence, I was surprised by the size of the discrepancy between patient reports and pharmacy fill records,” Wang said. “I suspect the ‘true’ answer is somewhere in between patient reports and pharmacy records, but both indicate that ensuring treatment adherence is still a huge problem.”

The study may have ended up with insufficient statistical power to identify a between-group difference for the co-primary endpoint, Wang said, as another surprising finding was that 28 percent of the patients who received vouchers chose not to use them. “We used vouchers to reduce co-payments because our patients were covered by multiple types of insurance and used a wide range of pharmacies and pharmacy benefit management services to obtain their medications,” she said. “But vouchers only provide the intended co-payment reduction if a patient chooses to or remembers to use it. Patients who never used the provided voucher had the highest rates of non-persistence and adverse clinical outcomes.”

Ultimately, co-payment reduction worked to improve medication prescription and use, Wang said.

“But our findings raise further questions about how best to deploy co-payment reduction to effectively improve clinical outcomes, as well as how to consider co-payment reduction strategies alongside other measures to improve patient adherence,” she said.

Wang and her colleagues said they hope to tease out answers to these questions through additional analysis of the study data.


Explore further:
Eliminating cost barriers helps heart patients comply with drug regimens

Provided by:
American College of Cardiology

Tagged with:

About author

Related Articles