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dc.contributor.authorRosen, Allison B.
dc.contributor.authorHamel, Mary Beth
dc.contributor.authorWeinstein, Milton C.
dc.contributor.authorCutler, David M.
dc.contributor.authorFendrick, A. Mark
dc.contributor.authorVijan, Sandeep
dc.date2022-08-11T08:10:44.000
dc.date.accessioned2022-08-23T17:18:06Z
dc.date.available2022-08-23T17:18:06Z
dc.date.issued2005-07-20
dc.date.submitted2011-01-14
dc.identifier.citationAnn Intern Med. 2005 Jul 19;143(2):89-99.
dc.identifier.issn0003-4819 (Linking)
dc.identifier.pmid16027450
dc.identifier.urihttp://hdl.handle.net/20.500.14038/47780
dc.description.abstractBACKGROUND: 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.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=16027450&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://www.annals.org/content/143/2/89.full.pdf+html
dc.subjectAged
dc.subjectAngiotensin-Converting Enzyme Inhibitors
dc.subjectCardiovascular Diseases
dc.subjectCost-Benefit Analysis
dc.subjectDiabetes Mellitus, Type 1
dc.subjectDiabetes Mellitus, Type 2
dc.subjectDiabetic Angiopathies
dc.subjectDiabetic Nephropathies
dc.subjectDisease Progression
dc.subjectDrug Costs
dc.subjectHumans
dc.subjectMarkov Chains
dc.subjectMedicare
dc.subjectPatient Compliance
dc.subjectQuality-Adjusted Life Years
dc.subjectSensitivity and Specificity
dc.subjectUnited States
dc.subjectBiostatistics
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titleCost-effectiveness of full medicare coverage of angiotensin-converting enzyme inhibitors for beneficiaries with diabetes
dc.typeJournal Article
dc.source.journaltitleAnnals of internal medicine
dc.source.volume143
dc.source.issue2
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/898
dc.identifier.contextkey1729432
html.description.abstract<p>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.</p> <p>OBJECTIVE: To estimate the cost-effectiveness to Medicare of first-dollar coverage (no cost sharing) of ACE inhibitors for beneficiaries with diabetes.</p> <p>DESIGN: Markov model with costs and benefits discounted at 3%.</p> <p>DATA SOURCES: Published literature and Medicare claims data.</p> <p>TARGET POPULATION: 65-year-old Medicare beneficiary with diabetes.</p> <p>TIME HORIZON: Lifetime.</p> <p>PERSPECTIVE: Medicare and societal.</p> <p>INTERVENTIONS: We evaluated Medicare first-dollar coverage of ACE inhibitors compared with current practice (no coverage) and the new Medicare drug benefit.</p> <p>OUTCOME MEASURES: Costs (2003 U.S. dollars), quality-adjusted life-years (QALYs), life-years, and incremental cost-effectiveness.</p> <p>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).</p> <p>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.</p> <p>LIMITATIONS: Results depend on accuracy of the underlying data and assumptions. The effect of more generous drug coverage on medication adherence is uncertain.</p> <p>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.</p>
dc.identifier.submissionpathqhs_pp/898
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.source.pages89-99


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