Abstract 18221: Choosing Wisely: Does It Apply to Prescription Drugs? A Cost Analysis of Utilization of Angiotensin Converting Enzyme Inhibitors Class of Drug Amongst Medicare Part D Beneficiaries
Introduction: ACE-Is were amongst top 10 most frequently prescribed medications in 2010 for Medicare part D beneficiaries. There are multiple generic agents available (10 in the US) in this class. The side effect profile of these medications is a class effect while the magnitude of benefit is largely similar. None of the major society guidelines recommend using one ACE-I preferentially over the other. We categorized various ACE-Is available in two categories: “Preferred” (Enalapril, Captopril, Benazepril, Ramipril and Lisinopril) and “Non-preferred ACE-I” (Moexipril, Fosinopril, Perindopril, Trandolapril and Quinapril). This classification is based mainly on the drug cost (Ramipril was included as preferred due to robust evidence). Recommendations from a previous publication by “consumerreport.org” on ACE-Is were taken into consideration as well.
Hypothesis: Selective prescribing of angiotensin converting enzyme-inhibitors (ACE-Is) can result in significant cost savings for Medicare.
Methods: We used CMS prescription drug profiles public use database for the year 2010, which contains data for 1,110 million prescription events for ~27 million Medicare part D beneficiaries. We included data only for drugs belonging to ACE inhibitor class. (fixed drug combinations were excluded).
Results: shown in tablet 1. Of all the prescription events related to ACE-I in 2010 (~46 million), non-preferred ACE-I accounted for 3 million events (6.7%) and for $78.8million (~14%) of the total cost. Average cost of a preferred ACE-I per prescription event was $11.41 vs $25.52 for non-preferred ACE-I. Considering the volume of prescription events during 2010, substitution of non-preferred ACE-I by preferred ACE-I would have translated into a total cost saving of $43.4 million for Medicare.
Conclusions: Although non-preferred ACE-Is constitute a small percentage of prescriptions, substituting with preferred ACE-I can translate into significant cost saving.
Author Disclosures: A. Sethi: None. M. Singh: None. D. Stapleton: None.
- © 2016 by American Heart Association, Inc.