Post-MI MACE unaffected by vouchers for P2Y12 inhibitors

  • Wang TY & al.
  • JAMA
  • 1 Jan 2019

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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).
  • MACE, however, did not differ between groups at 1 year (10.6% no voucher vs 10.2% with voucher; P=.65):
    • Adjusted HR: 1.07 (95% CI, 0.93-1.25).

Study design

  • Included 301 hospitals randomly assigned to provide usual care (no voucher, 166) or vouchers (135); n=11,001 patients.
  • Funding: AstraZeneca.

Limitations

  • Included only patients with US insurance offering prescription coverage.
  • Not all prescription-fill records available.
  • Enrollment rates varied by arm.