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Research article
Florian Kirsch
Helmholtz Zentrum Munchen Deutsches Forschungszentrum fur Umwelt und Gesundheit
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0543-592X
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background: Acute myocardial infarction (AMI), a major source of morbidity and mortality, is also associated with excess costs. Findings from previous studies were divergent regarding the effect of adherence to guideline-recommended medication on health care expenditure. However, gender-specific medication effectiveness, correlating effectiveness of concomitant medication and variation in adherence over time were not yet considered.
Methods: We aim to measure this from a third-party payer’s perspective in a sample of statutory insured Disease Management Program participants over a follow-up period of 3-years. In 3,627 AMI patients, the proportion of days covered (PDC) for four guideline-recommended medications were calculated. A generalized additive mixed model was used, taking into account inter-individual effects (mean PDC-rate) and intra-individual effects (deviation from the mean PDC-rate).
Results: For the inter-individual effect, only anti-platelet agents had a significant negative influence, higher mean PDC rates lead to higher costs in both sexes. For the intra-individual effect, a higher deviation from the mean PDC-rate for ACE-inhibitors, anti-platelet agents, and statins was associated with higher costs in females. Further, in males, for β-blockers an increasing positive deviation from the PDC-mean increases costs and a negative deviation decreases costs. For anti-platelet agents an increasing deviation from the PDC-mean slightly increases costs.
Conclusion: Positive and negative deviation from the mean PDC-rate, independent of how high the mean was, usually negatively affect health care expenditures. Therefore, continuity in intake of guideline recommended medication is important to save costs.
Keywords
AMI, health care expenditures, PDC, secondary prevention, guideline-based medication, DMP
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This preprint is under consideration at BMC Health Services Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Florian Kirsch
Helmholtz Zentrum Munchen Deutsches Forschungszentrum fur Umwelt und Gesundheit
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0543-592X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 01 Jul, 2020
Published
On 20 Dec, 2020
No community comments so far
Editor assigned
On 28 Jun, 2020
Submission checks complete
On 27 Jun, 2020
Editor invited
On 27 Jun, 2020
First submitted
On 25 Jun, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background: Acute myocardial infarction (AMI), a major source of morbidity and mortality, is also associated with excess costs. Findings from previous studies were divergent regarding the effect of adherence to guideline-recommended medication on health care expenditure. However, gender-specific medication effectiveness, correlating effectiveness of concomitant medication and variation in adherence over time were not yet considered.
Methods: We aim to measure this from a third-party payer’s perspective in a sample of statutory insured Disease Management Program participants over a follow-up period of 3-years. In 3,627 AMI patients, the proportion of days covered (PDC) for four guideline-recommended medications were calculated. A generalized additive mixed model was used, taking into account inter-individual effects (mean PDC-rate) and intra-individual effects (deviation from the mean PDC-rate).
Results: For the inter-individual effect, only anti-platelet agents had a significant negative influence, higher mean PDC rates lead to higher costs in both sexes. For the intra-individual effect, a higher deviation from the mean PDC-rate for ACE-inhibitors, anti-platelet agents, and statins was associated with higher costs in females. Further, in males, for β-blockers an increasing positive deviation from the PDC-mean increases costs and a negative deviation decreases costs. For anti-platelet agents an increasing deviation from the PDC-mean slightly increases costs.
Conclusion: Positive and negative deviation from the mean PDC-rate, independent of how high the mean was, usually negatively affect health care expenditures. Therefore, continuity in intake of guideline recommended medication is important to save costs.
Figure 1
Figure 2
Figure 3
Figure 4
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