Tuesday, September 25, 2012

Free Drugs 2: Escape from Copay Cove

Previously on Public Health Stories
I ate pastries of questionable origins.  Harvard researcher Dr. Dr. Niteesh Choudhry gave away heart medications for free.  The trial lasted about 2.5 years.  During that time, he threatened to fire me 31 times. 

So what happens when people get their medications for free?

(Drinking appears to be OK.  Isle of Skye, Scotland)
They take it!  Patients in the free drugs group adhered statistically significantly better by 4 to 6 percentage points.   

But not enough of it…  In the usual payment group, rates of adherence ranged from 35.9-49.0%, depending on the type of heart medication.  In the free group, adherence ranged from 41.5-55.2%, a big improvement, yes, but it also means that despite being offered free drugs, about half of the patients did not take advantage of these medicines essential to keep their hearts healthy and complication-free.

They stay just as healthy.  Patients who took the free drugs had fewer major heart complications than the usual payment patients.  But the difference was not significant (21.5% vs. 23.3%).  Patients in both groups generally performed the same when it came to the primary outcomes of interest (readmission for the first major heart problem), but when it came to certain secondary outcomes, patients in the free drug group had statistically significantly lower rates of major vascular events or revascularization.

They save lots of money.  Perhaps it was obvious that people getting drugs for free would have to spend less money on healthcare, but thinking of the whopping 30% they saved on overall drug spending and 18% on (non-drug) medical spending is pretty awesome when you consider that as more insurers adopt VBID (value-based insurance design, if you forgot from last week), you could be seeing these savings soon.

They don’t cost your arm and leg.  Despite the fact that the insurer had to foot the bill for free drugs, overall spending on the free group was actually 11% less than the usual payment group.  Insurers spent an extra 32% on drugs for the free drug group, but total spending for the free drug group was $66,008, compared to $71,778 for the usual payment group.  Though this difference of $5,770 is not statistically significant, the association is strong.  Getting better health quality (higher adherence) while saving patients money (free drugs) and not adding on the insurer’s total costs (i.e. other people’s free drugs won’t affect your premiums) is a rare and special win-win-draw in health policy.  So much so that the insurer is sticking with free medications for the time being.

Policy Implication: VBID can improve health quality without increasing costs. 

Full disclosure: Despite the generous things I said about him last week, I continue to work with Niteesh and believe in his greatness.  He continues to not coerce/pay me to promote him.  I am disappointed.

PS. If you’re smarter than I write and want to know more about the trial, I encourage you to check out the rationale and the primary analysis papers yourself. 


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