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The European Journal of Health Economics
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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

Authors: Florian Kirsch; Christian Becker; Anja Schramm; Werner Maier; Reiner Leidl;

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

Abstract

AbstractObjectiveAcute 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.MethodsThe 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.ResultsThe 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).ConclusionPrevious 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.

Keywords

Male, Survival, Adrenergic beta-Antagonists, Myocardial Infarction, Angiotensin-Converting Enzyme Inhibitors, Coronary Artery Disease, Kaplan-Meier Estimate, AMI, DMP CAD, Insurance Claim Review, Germany, Health care expenditures, Humans, Guideline-based medication, Propensity Score, H51, Proportional Hazards Models, Assessment of Medication Adherence, ddc:610, Original Paper, I18, I11, Antibodies, Monoclonal, Disease Management, Drug Combinations, Practice Guidelines as Topic, Medication Adherence/statistics ; I11 ; Drug Combinations [MeSH] ; Coronary Artery Disease/economics [MeSH] ; Practice Guidelines as Topic [MeSH] ; Health Expenditures/statistics ; Disease Management [MeSH] ; Germany/epidemiology [MeSH] ; Platelet Aggregation Inhibitors/administration ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration ; Survival ; Proportional Hazards Models [MeSH] ; Male [MeSH] ; Adrenergic beta-Antagonists/administration ; Propensity Score [MeSH] ; I18 ; Angiotensin-Converting Enzyme Inhibitors/administration ; AMI ; Female [MeSH] ; Coronary Artery Disease/mortality [MeSH] ; Insurance Claim Review [MeSH] ; Kaplan-Meier Estimate [MeSH] ; H51 ; Humans [MeSH] ; Coronary Artery Disease/drug therapy [MeSH] ; Antibodies, Monoclonal [MeSH] ; Guideline-based medication ; Coronary Artery Disease/epidemiology [MeSH] ; Myocardial Infarction/epidemiology [MeSH] ; DMP CAD ; Original Paper ; Health care expenditures, Female, Health Expenditures, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Platelet Aggregation Inhibitors

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
11
Top 10%
Average
Top 10%
Green
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