Providing free medications to people after heart attack could add years to patients' lives at a relatively low cost for provincial governments, according to a new study by researchers at St. Michael's Hospital in Toronto.
"Many patients are not benefiting from effective prescribed medications because they simply don't fill their prescriptions," says Dr. Irfan Dhalla, the study's lead author and a physician at St. Michael's Hospital. "There is growing evidence that having to pay for medications out of pocket is a major reason."
Public coverage of pharmaceuticals in Canada is neither universal nor uniform because the Canada Health Act covers only physician and hospital services. According to data published in 2005, 11 per cent of Canadians had only catastrophic public coverage, and 4 per cent had no coverage at all.
The goal of the study was to demonstrate to policymakers what would happen if governments fully covered the costs of five heart attack medications—a beta blocker, low-dose aspirin, an ACE inhibitor, a statin, and a relatively new drug called clopidogrel—which are routinely prescribed for patients who have survived a heart attack.
The use of these effective and relatively inexpensive drugs has led to a dramatic decline in deaths from cardiovascular disease in recent years. Between 1980 and 2000, mortality from cardiovascular disease in Canada decreased by approximately 50%.
The researchers compared the benefits and the costs of two options:
The "status quo" option reflects the current situation across Canada where people who don't have private drug insurance or who aren't eligible for government-funded drug programs are expected to pay the full cost of their prescriptions after a heart attack.
The "full coverage" option would see governments pay the full cost of five recommended medications.
Implementing the full-coverage strategy for the five medications would result in average survival of 7.02 quality-adjusted life-years (QALYs) after heart attack at an average cost of $20,423 per patient, the study found.
The status quo strategy resulted in an average survival of 6.13 QALYs at an average cost of $17,173 per patient.
(In health care research, the term "QALY" is used to describe survival time based not just on quantity of years but also on quality of life. A year in perfect health is considered equal to 1.0 QALY. The value of a year in ill health would be lower—for example, a year spent in hospital might have a value equal to 0.5 QALY.)
"Full coverage would save lives at very low cost and would be cost-effective compared to the status quo," says Dr. Dhalla. "Our model suggests that providing free medications to people after heart attack would result in one more year of life for each additional $3,663 spent by government. We used very conservative assumptions, and it is quite possible that a full coverage strategy would even be cost-saving for governments over the long-term."
The researchers say any added cost would be significantly below current thresholds used to decide whether new drugs and medical devices should be eligible for public funding.
Although the study looked at heart attack because that is where the evidence is strongest, there are many diseases where cheap, effective medications are available.
"Policy makers may wish to consider providing medications free of charge to all patients with chronic illnesses where specific drug treatments are known to be both highly cost-effective and associated with poor adherence—for example, preventing kidney and cardiovascular disease in patients with diabetes," Dr. Dhalla says. "Providing medications free of charge where they are likely to have the most value is one way policy makers can allocate limited public resources more efficiently."
About St. Michael's Hospital
St. Michael's Hospital provides compassionate care to all who walk through its doors. The Hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing Knowledge Institute, research at St. Michael's Hospital is recognized and put into practice around the world. Founded in 1892, the Hospital is fully affiliated with the University of Toronto.
Julie Saccone | EurekAlert!
Norovirus evades immune system by hiding out in rare gut cells
12.10.2017 | University of Pennsylvania School of Medicine
Flexible sensors can detect movement in GI tract
11.10.2017 | Massachusetts Institute of Technology
University of Maryland researchers contribute to historic detection of gravitational waves and light created by event
On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...
Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.
Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....
Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).
When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...
Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.
How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...
Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.
It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...
17.10.2017 | Event News
10.10.2017 | Event News
10.10.2017 | Event News
17.10.2017 | Life Sciences
17.10.2017 | Life Sciences
17.10.2017 | Earth Sciences