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| |  Canadian Cardiovascular Outcomes Improve With Faster Access to Clopidogrel: Presented at CCC By Marvin Ross TORONTO -- October 29, 2008 -- An administrative change allowing for faster access to clopidogrel in Canada led to improved coronary stenting and improved cardiovascular outcomes, according to research presented here at the Canadian Cardiovascular Congress (CCC). Preauthorisations for drug reimbursements may have an adverse effect on patients' outcomes if they interfere with timely access to efficacious medications. Clopidogrel, in combination with aspirin, is the recommended standard of care for patients receiving coronary stents to prevent thrombosis, noted Cynthia A. Jackevicius, PharmD, Western University of Health Sciences College of Pharmacy, Pomona, California, and University of Toronto Faculty of Medicine, Toronto, Ontario. Dr. Jackevicius explained the findings from her population-based, retrospective time-series analysis presented here on October 26. The study, conducted from April 1, 2000, to March 31, 2005, examined subjects at least 65 years old with acute myocardial infarction (MI), who underwent percutaneous coronary intervention (PCI) with stenting in Ontario, Canada. The primary outcome of the study was the composite rate of death, recurrent acute MI, PCI, and coronary artery bypass grafting (CABG) at 1 year, with adjustment for sex and age. The secondary outcome was major bleeding. The study intervention was a change in reimbursement policies for clopidogrel that occurred in September 2003. The Canadian government had implemented a restricted reimbursement policy for clopidogrel when it first entered the national market in October 1998. Physicians had to submit a letter justifying their use of clopidogrel for each patient. From April 2002 to March 2003, about 90% of clopidogrel claims were approved after clinical review. To improve system efficiency, the payer changed the policy to "limited use" in September 2003. Clopidogrel was approved for acute coronary syndromes and PCI. The 5-year study period was divided into monthly intervals for 60 consecutive data points. The date of the clopidogrel use was defined as the date of the first prescription after discharge following MI. During the prior authorisation period, there were 3,428 patients, compared to 2,733 in the limited-use period. The mean time to first use of clopidogrel in the prior period was 37 days compared to only 6 days in the limited-use period (P < .001). Readmission for acute MI within 365 days after hospital discharge occurred in 5% of the prior-authorisation patients but in only 3% of the limited-use patients (P < .001). PCI within 365 days after hospital discharge occurred in 7% of prior-authorisation patients versus 5% of limited-use patients (P < .001). The comparisons for CABG within 365 days were 2% in prior-authorisation patients and 1% in limited-use patients (P < .001). Readmissions for acute MI, death, PCI, or CABG within 365 days after hospital discharge were also significantly different between the prior-authorisation patients and the limited-use patients at 15% and 11%, respectively (P < .001).
[Presentation title: Cardiovascular Outcomes With Removal of Clopidogrel Prior Authorization in Patients Receiving Coronary Stents Post-Myocardial Infarction. Abstract 099-039]
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