Patients with coronary artery disease after acute myocardial infarction: effects of continuous enrollment in a structured Disease Management Program on adherence to guideline-recommended medication, health care expenditures, and survival.
Adrenergic beta-Antagonists
/ administration & dosage
Angiotensin-Converting Enzyme Inhibitors
/ administration & dosage
Antibodies, Monoclonal
Coronary Artery Disease
/ drug therapy
Disease Management
Drug Combinations
Female
Germany
/ epidemiology
Health Expenditures
/ statistics & numerical data
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
/ administration & dosage
Insurance Claim Review
Kaplan-Meier Estimate
Male
Medication Adherence
/ statistics & numerical data
Myocardial Infarction
/ epidemiology
Platelet Aggregation Inhibitors
/ administration & dosage
Practice Guidelines as Topic
Propensity Score
Proportional Hazards Models
AMI
DMP CAD
Guideline-based medication
Health care expenditures
Survival
Journal
The European journal of health economics : HEPAC : health economics in prevention and care
ISSN: 1618-7601
Titre abrégé: Eur J Health Econ
Pays: Germany
ID NLM: 101134867
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
16
04
2019
accepted:
06
01
2020
pubmed:
2
2
2020
medline:
10
3
2021
entrez:
2
2
2020
Statut:
ppublish
Résumé
Acute myocardial infarction (AMI) carries increased risk of mortality and excess costs. Disease Management Programs (DMPs) providing guideline-recommended care for chronic diseases seem an intuitively appealing way to enhance health outcomes for patients with chronic conditions such as AMI. The aim of the study is to compare adherence to guideline-recommended medication, health care expenditures and survival of patients enrolled and not enrolled in the German DMP for coronary artery disease (CAD) after an AMI from the perspective of a third-party payer over a follow-up period of 3 years. The study is based on routinely collected data from a regional statutory health insurance fund (n = 15,360). A propensity score matching with caliper method was conducted. Afterwards guideline-recommended medication, health care expenditures, and survival between patients enrolled and not enrolled in the DMP were compared with generalized linear and Cox proportional hazard models. The propensity score matching resulted in 3870 pairs of AMI patients previously and continuously enrolled and not enrolled in the DMP. In the 3-year follow-up period the proportion of days covered rates for ACE-inhibitors (60.95% vs. 58.92%), anti-platelet agents (74.20% vs. 70.66%), statins (54.18% vs. 52.13%), and β-blockers (61.95% vs. 52.64%) were higher in the DMP group. Besides that, DMP participants induced lower health care expenditures per day (€58.24 vs. €72.72) and had a significantly lower risk of death (HR: 0.757). Previous and continuous enrollment in the DMP CAD for patients after AMI is a promising strategy as it enhances guideline-recommended medication, reduces health care expenditures and the risk of death.
Identifiants
pubmed: 32006188
doi: 10.1007/s10198-020-01158-z
pii: 10.1007/s10198-020-01158-z
pmc: PMC7214389
doi:
Substances chimiques
Adrenergic beta-Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Antibodies, Monoclonal
0
Drug Combinations
0
Hydroxymethylglutaryl-CoA Reductase Inhibitors
0
Platelet Aggregation Inhibitors
0
combotox
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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