Use Of Secondary Prevention Medication And Economic Burdern Among Patients With Acute Coronary Syndromes

Objectives: To estimate the use of secondary prevention medications,health care resource utilization and direct medical costs for patients with acute coronary syndrome(ACS)in Tianjin,China.Methods: Data were obtained from Tianjin Urban Employee Basic Medical Insurance database(2011-2015).Adult patients with primary discharge diagnosis of ACS between 2012 and 2014 were included.The use of secondary prevention medications,ACS-related and all-cause health care resource utilization and direct medical costs during 12 months follow-up period were retrospectively analyzed.Study medications included antiplatelets,?-blockers,angiotensin converting enzyme inhibitors(ACEIs)/ angiotensin receptor blockers(ARBs),and statins.We considered the medications strategy as optimal medical therapy(OMT)if patients had prescriptions of all above 4 class medications.Patients were classified into OMT cohort and Non-OMT cohort according to whether they received OMT at discharge.The propensity score matching(PSM)was employed to adjust for potential confounders of two cohorts prior to outcomes analyses.Differences between the subgroups regarding above outcomes were also assessed.Multiple linear regression models and generalized linear models(GLM)were applied to identify factors associated with the length of stay and direct medical costs,respectively.Results: A total of 22,041 patients were included,with mean age of 64.7(±10.7)years and 45.6% female.OMT at discharge was received in 3,336(15.1%)patients and decreased over time.Annual mean all-cause costs were 21,346 CNY per patient with ACS-related costs accounting for 35.9%.For ACS-related health services,18.6% of patients experienced ?1 hospitalization with mean length of stay of 10.3(±7.4)days and mean cost of 19,054 CNY per admission,while 88.7% of patients experienced ?1 outpatient visit with mean(±SD)number of visits 12.7(±9.9)and mean cost 266 CNY per visit.The medication costs were the largest component(52.1%)of ACS-related total costs.After propensity-score matching,there were 3,336 patients in each cohort and no statistically significant differences remained between matched cohorts regarding baseline characteristics.The use of medications were significantly more frequently in OMT-cohort compared with Non-OMT cohort during the 12 months follow up(P<0.05).And more OMT patients had ACS-related outpatient visits(95.6% vs.92.6%,P<0.001),while less OMT patients experienced ACS-related hospitalization(16.6% vs.20.2%,P<0.001).The results of models demonstrated that OMT at discharge was associated with shorter ACS-related length of stay and tended to reduce inpatient costs.Conclusions: The use of secondary prevention among ACS patients was suboptimal and cost was considerable,which mainly driven by hospitalizations.Efforts focused on improving the use of effective secondary prevention medications and reducing the utilization of inpatient services may bring about meaningful costs savings of ACS.