Going beyond the mean: economic benefits of myocardial infarction secondary prevention
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(2020) 20:1125
RESEARCH ARTICLE
Open Access
Going beyond the mean: economic benefits of myocardial infarction secondary prevention Viktor von Wyl1,2* , Agne Ulyte1, Wenjia Wei1, Dragana Radovanovic1, Oliver Grübner1,3, Beat Brüngger1,4, Caroline Bähler1,4, Eva Blozik3,5, Holger Dressel1 and Matthias Schwenkglenks1
Abstract Background: Using the example of secondary prophylaxis of myocardial infarction (MI), our aim was to establish a framework for assessing cost consequences of compliance with clinical guidelines; thereby taking cost trajectories and cost distributions into account. Methods: Swiss mandatory health insurance claims from 1840 persons with hospitalization for MI in 2014 were analysed. Included persons were predominantly male (74%), had a median age of 73 years, and 71% were preexposed to drugs for secondary prophylaxis, prior to index hospitalization. Guideline compliance was defined as being prescribed recommended 4-class drug prophylaxis including drugs from the following four classes: betablockers, statins, aspirin or P2Y12 inhibitors, and angiotension-converting enzyme inhibitors or angiotensin receptor blockers. Health care expenditures (HCE) accrued over 1 year after index hospitalization were compared by compliance status using two-part regression, trajectory analysis, and counterfactual decomposition analysis. Results: Only 32% of persons received recommended 4-class prophylaxis. Compliant persons had lower HCE (− 4865 Swiss Francs [95% confidence interval − 8027; − 1703]) and were more likely to belong to the most favorable HCE trajectory (with 6245 Swiss Francs average annual HCE and comprising 78% of all studied persons). Distributional analyses showed that compliance-associated HCE reductions were more pronounced among persons with HCE above the median. Conclusions: Compliance with recommended prophylaxis was robustly associated with lower HCE and more favorable cost trajectories, but mainly among persons with high health care expenditures. The analysis framework is easily transferrable to other diseases and provides more comprehensive information on HCE consequences of noncompliance than mean-based regressions alone. Keywords: Health care costs, Compliance, Causality, Costs and cost analysis Jel: I10
* Correspondence: [email protected] 1 Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland 2 Institute for Implementation Science in Health Care, University of Zurich, Universitätsstrasse 84, 8006 Zurich, Switzerland Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third part
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