Abstract 1285: Potential Cost Savings With Restrictive Access to Angiotensin-Receptor Blockers in Canada: A Decision Analysis Model
Background: Cardiovascular (CV) drug costs increased by >200% over the last 10 years in Canada. Angiotensin-receptor blocker (ARB) use grew at an especially high rate. No study has shown incremental benefit of ARB over angiotensin-converting enzyme inhibitors (ACEI) aside from a reduction in dry cough. We estimated the cost-savings that would have been achieved by restricting access to ARB.
Method: We performed a cost-minimization analysis over a 1 year time horizon. We used a decision analysis model from a societal perspective, which compared the actual 2006 expenditures for ACEI and ARB for each Canadian province to the predicted costs of a restrictive access policy for ARB. IMS Health Canada data was used to estimate actual use and cost of ACEI and ARB in each province. We assumed that ACEI and ARB exert a class effect and were equivalent in their effectiveness for the treatment of CV conditions. The model also assumed a 20% rate of dry cough with ACEI. Fees from physician consultations associated with switching from ACEI to ARB in the event of dry cough and administrative costs were included in the total cost inferred by the restriction policy. Only direct costs were considered. Monte Carlo simulation with 10 000 iterations were used to evaluate the parameter uncertainty associated with drug prices, administrative costs and the incidence of dry cough. Results are in 2006 $CND.
Results: The base case scenario and sensitivity analyses results are presented in Table⇓. Such a policy would have saved $59 270 462 in Canada. Monte Carlo simulations yielded average savings of $59M, ranging from $166M in savings to $8M in additional costs. Over 95% of simulations showed cost-savings.
Conclusion: A more restrictive policy on access to ARB would have saved the Canadian healthcare system over $59M in 2006, likely without any adverse effect on CV health. Such strategies need to be considered by public and private drug insurance plans in order to contain the steadily increasing costs of CV care.