Cost-Effectiveness From the Patient's View: Study Compares 2 Drugs

Too often in healthcare, the main concern of insurers and health professionals becomes focused on financial optimization over patient benefit. A recent University of Michigan Medical School study analyzed the true cost-effectiveness between 2 stroke medications: from the viewpoint of society and the insurer and from the viewpoint of the patient. The 2 drugs were dabigatran, a powerful but expensive therapy, and warfarin, a much cheaper but also less effective therapy.

The study analyzed findings from previous studies about the use of the 2 drugs in patients over the age of 65 years who had atrial fibrillation, increased risk of stroke, Medicare coverage, and no contraindications to anticoagulants. Quality-adjusted life expectancy, net costs, and adverse event risks were calculated for 35 years or until death by each payer perspective: society, Medicare, and the patient. The incremental cost-effective ratio (ICER) was the variable of comparison. A “cost-saving” ICER occurred when quality-adjusted life years outweighed overall costs.

Results showed that dabigatran is more cost-effective than warfarin from societal and Medicare perspectives, but when it comes to the patient’s perspective, it’s not so clear cut. For patients with Medicare Part D prescription drug coverage, dabigatran was cost-saving, but for patients without insurance the treatment was more costly. In other words, those without coverage would have to pay more than the worth of the therapeutic benefit they would receive from the drug. Adults without Medicare Part D coverage represents a sizeable percentage of the population, with vulnerability to the high costs of newer, more effective medications like dabigatran.

The study results demonstrate the idea that prescription coverage has a significant effect on what therapies are most cost-effective for patients. It all comes down to whether the cost of the medication (associated with insurance coverage) is worth the quality years a patient can gain (associated with patient’s risk of stroke).

With so many benefit/risk calculations to consider when it comes to choosing a medication, patients can become overwhelmed. Therefore, doctors and patients need to collaborate to choose therapies based on individual circumstances and coverage.

The patient-centered approach from this study can also be utilized to study other drugs on the market that have cheaper alternatives or more effective counterparts in order to decide the best treatment for the patient.

“The patient needs to be an important part of the decision about which anticoagulant strategy to choose,” the study’s lead author Geoff Barnes, MD, MSc, said in a statement. “If they don’t know what it will cost them, they can’t make an informed decision. Based on this study, we can give patients and physicians good cost-benefit data to use in that discussion.”