Earlier this month at an American College of Cardiology meeting, Dr. Tracy Wang, Associate Professor at Duke School of Medicine, presented preliminary findings on a study involving 11,000 heart attack patients in 300 U.S. hospitals. Funded by the drug maker AstraZeneca, the ARTEMIS study aimed to understand which blood-thinning drugs patients were being prescribed in the wake of their heart attacks and how well those patients stuck to the prescribed medicine over the course of a year. In particular, researchers wanted to understand if the high-cost but more effective brand-name drug (ticagregol) would be more commonly prescribed and used if patients were provided a voucher to offset its extra cost compared to an older generic therapy called clopidogrel.
Hospitals were randomly assigned to a “care as usual” arm and a “co-pay intervention arm” – in the latter, price-equalizing vouchers were available for all patients and doctors were given discretion to prescribe either type of treatment. As expected, clinicians were more likely to prescribe the more effective brand-name drug when they knew patients would not be facing a higher cost. Additionally, patients who received vouchers and used them were more likely to continue taking the medication as prescribed over the course of a year. However, there was no difference in death rates, heart attacks, or strokes between those in the voucher group and the “care as usual” group.
The preliminary results indicate that cost is a huge factor when doctors choose which treatments to prescribe and when patients decide to fill – or not fill – prescriptions. However, reducing cost alone is not sufficient to improve health outcomes. Broader interventions are needed to improve patient health and co-payment reduction can be an important piece of a multi-pronged approach. As Dr. Wang explained, “Our study confirms some of our thoughts on how drug prices affect doctors’ and patients’ behaviors, but we still have a lot of work to do to understand how we can both measure and improve treatment adherence.”