当前位置: X-MOL 学术Circ. Cardiovasc. Qual. Outcomes › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Copayment Reduction Voucher Utilization and Associations With Medication Persistence and Clinical Outcomes: Findings From the ARTEMIS Trial.
Circulation: Cardiovascular Quality and Outcomes ( IF 6.9 ) Pub Date : 2020-05-12 , DOI: 10.1161/circoutcomes.119.006182
Alexander C Fanaroff 1 , Eric D Peterson 2, 3 , Lisa A Kaltenbach 3 , Kevin J Anstrom 3 , Gregg C Fonarow 4 , Timothy D Henry 5 , Christopher P Cannon 6 , Niteesh K Choudhry 7 , David J Cohen 8 , Nipun Atreja 9 , Narinder Bhalla 9 , James M Eudicone 9 , Tracy Y Wang 2, 3
Affiliation  

BACKGROUND Cost is frequently cited as a barrier to optimal medication use, but the extent to which copayment assistance interventions are used when available, and their impact on evidence-based medication persistence and major adverse cardiovascular events is unknown. METHODS AND RESULTS The ARTEMIS trial (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) randomized 301 hospitals to usual care versus the ability to provide patients with vouchers that offset copayment costs when filling P2Y12 inhibitors in the 1 year post-myocardial infarction. In the intervention group, we used multivariable logistic regression to identify patient and medication cost characteristics associated with voucher use. We then used this model to stratify both intervention and usual care patients by likelihood of voucher use, and examined the impact of the voucher intervention on 1-year P2Y12 inhibitor persistence (no gap in pharmacy supply >30 days) and major adverse cardiovascular events (all-cause death, myocardial infarction, or stroke). Among 10 102 enrolled patients, 6135 patients were treated at hospitals randomized to the copayment intervention. Of these, 1742 (28.4%) never used the voucher, although 1729 (99.2%) voucher never-users filled at least one P2Y12 inhibitor prescription in the 1 year post-myocardial infarction. Characteristics most associated with voucher use included: discharge on ticagrelor, planned 1-year course of P2Y12 inhibitor treatment, white race, commercial insurance, and higher out-of-pocket medication costs (c-statistic 0.74). Applying this propensity model to stratify all enrolled patients by likelihood of voucher use, the intervention improved medication persistence the most in patients with high likelihood of voucher use (adjusted interaction P=0.03, odds ratio, 1.86 [95% CI, 1.48-2.33]). The intervention did not significantly reduce major adverse cardiovascular events in any voucher use likelihood group, although the odds ratio was lowest (0.86 [95% CI, 0.56-1.16]) among patients with high likelihood of voucher use (adjusted interaction P=0.04). CONCLUSIONS Among patients discharged after myocardial infarction, those with higher copayments and greater out-of-pocket medication costs were more likely to use a copayment assistance voucher, but some classes of patients were less likely to use a copayment assistance voucher. Patients at low likelihood of voucher use benefitted least from copayment assistance, and other interventions may be needed to improve medication-taking behaviors and clinical outcomes in these patients. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02406677.

中文翻译:

共付额减少券的使用以及与药物持久性和临床结果的关联:ARTEMIS试验的发现。

背景技术成本经常被认为是最佳药物使用的障碍,但是共付援助干预措施在可行时的使用程度以及它们对循证药物持续性和重大心血管不良事件的影响尚不清楚。方法和结果ARTEMIS试验(心肌梗死研究后的可负担性和现实世界抗血小板治疗效果)将301家医院随机分配至常规护理,而不是在心肌梗死后1年使用P2Y12抑制剂为患者提供可抵销共付额的优惠券的能力。在干预组中,我们使用多元逻辑回归来确定与使用凭证相关的患者和用药成本特征。然后,我们使用此模型通过使用优惠券的可能性对干预患者和常规护理患者进行了分层,并检查了优惠券干预对1年P2Y12抑制剂持续性(药房供应无间隙> 30天)和重大心血管不良事件的影响(全因死亡,心肌梗塞或中风)。在10102名登记患者中,有6135名患者在随机接受共付干预的医院接受了治疗。其中有1742(28.4%)从未使用过该凭证,尽管1729(99.2%)从未使用过凭证的人在心肌梗塞后1年内至少填写了一份P2Y12抑制剂处方。与使用凭证最相关的特征包括:替卡格雷的出院,计划的P2Y12抑制剂治疗1年疗程,白人,商业保险以及自付费用更高的药物(c统计值为0.74)。应用此倾向模型按使用凭证的可能性对所有入组患者进行分层,在使用凭证的可能性较高的患者中,干预措施最大程度地改善了药物的持久性(调整后的交互作用P = 0.03,优势比为1.86 [95%CI,1.48-2.33] )。尽管在使用凭证的可能性高的患者中,优势比最低(0.86 [95%CI,0.56-1.16])(调整后的交互作用P = 0.04),但在任何使用凭证的可能性组中,干预措施均未显着降低重大心血管不良事件。 。结论在心肌梗死后出院的患者中,具有较高共付额和自付费用的药物费用较高的人更有可能使用共付额补助券,但是某些类别的患者不太可能使用共付额补助券。使用代金券可能性低的患者从共付额援助中受益最少,可能需要其他干预措施来改善这些患者的用药行为和临床结局。注册:URL:https://www.clinicaltrials.gov。唯一标识符:NCT02406677。
更新日期:2020-05-12
down
wechat
bug