- Post-myocardial infarction (MI), copayment vouchers for P2Y12 inhibitors did nothing to reduce major cardiac adverse event (MACE) outcomes at 1 year.
- Vouchers were associated with a small increase in patient-reported therapy persistence in the large randomized ARTEMIS trial involving 301 US hospitals.
Why this matters
- Costs had been pinpointed as a factor in therapy nonadherence.
- Vouchers to offset costs were expected to help with guidelines-based adherence and with outcomes.
- Editorial: a 1-size-fits-all approach might be easiest for clinicians and a freighted health care system, but individual patient needs and interests need to be foregrounded.
- Almost all patients were prescribed clopidogrel or ticagrelor.
- Vs no voucher, those receiving vouchers had higher therapy persistence at 1 year:
- No voucher: 83.8% (3324/3967);
- Voucher: 87.0% (5340/6135; P<.001>
- Adjusted difference: 2.3% (95% CI, 0.4%-4.1%).
- aOR: 1.19 (95% CI, 1.02-1.40).
- Adjusted HR: 1.07 (95% CI, 0.93-1.25).
- Included 301 hospitals randomly assigned to provide usual care (no voucher, 166) or vouchers (135); n=11,001 patients.
- Funding: AstraZeneca.
- Included only patients with US insurance offering prescription coverage.
- Not all prescription-fill records available.
- Enrollment rates varied by arm.