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Cardiovascular medicine
Original research
Pharmaceutical use and costs in patients with coronary artery disease, using Australian observational data
  1. Victoria McCreanor1,2,
  2. William A Parsonage1,3,
  3. David C Whiteman4,5,
  4. Catherine Olsen4,5,
  5. Adrian G Barnett1,
  6. Nicholas Graves1
  1. 1 Australian Centre for Health Services Innovation (AusHSI), Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
  2. 2 Capital Markets CRC Ltd, Sydney, New South Wales, Australia
  3. 3 Cardiology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  4. 4 QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
  5. 5 Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Victoria McCreanor; victoria.mccreanor{at}qut.edu.au

Abstract

Objectives We aimed to estimate the annual pharmaceutical costs for patients with stable coronary artery disease, using Australian administrative data, comparing patients who had undergone interventional treatment with those had not. We also aimed to compare the duration of dual antiplatelet therapy (DAPT) prescription in the real-world, with recommended guidelines.

Design An observational study using administrative data.

Participants We used data from the QSkin study, a population-based prospective study assessing skin cancer risk. Participants were invited from the Queensland population, not based on perceived skin cancer risk, and had consented to future use of their data for approved research projects.

Main outcome measures We calculated 12-month costs of pharmaceutical therapy for coronary artery disease for patients in each of three clinically relevant groups: medical therapy only, following coronary stent implantation and following coronary artery bypass graft surgery. We measured the duration of DAPT following stent implantation and total duration of DAPT, where it was prescribed, in the medical therapy only group.

Results Estimated mean annual pharmaceutical costs were highest in the stent group at AUD$1920, compared with AUD$1481 in the medical therapy group, and AUD$881 in the coronary artery bypass group. There were similar rates of prescriptions of symptom relief drugs following stent insertion, compared with the medical therapy only group. The median duration of DAPT in the stent group was 16, and 31 months in the medical therapy group.

Conclusions Our results suggest that despite the common expectation that the burden of medical therapy is reduced following coronary stent insertion for stable coronary artery disease, this does not occur in practice. Many patients also appear to continue DAPT longer than guidelines recommend, which may put them at unnecessarily elevated risk of bleeding events.

  • coronary heart disease
  • quality in health care
  • health policy
  • health economics

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-029360

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    Footnotes

    • Contributors VM and WAP contributed to study design, analysis methods and revisions of the manuscript. VM performed the analyses and prepared the first draft of the manuscript. NG and AGB contributed to analysis methods and revisions of the manuscript. DCW and CO developed the QSkin study, were responsible for the data collection and cleaning and reviewed the manuscript. All the authors gave their approval for the final version of the manuscript. All the authors agree to be accountable for all aspects of the manuscript.

    • Funding The QSkin Study is supported by a programme grant (APP1073898) from the National Health and Medical Research Council of Australia (NHMRC). DCW is supported by a research fellowship from the NHMRC. VM receives PhD Scholarship funding from the Capital Markets Cooperative Research Centre.

    • Competing interests None declared.

    • Patient consent for publication Not applicable.

    • Ethics approval The Human Research Ethics Committee at the QIMR Berghofer Medical Research Institute approved the QSkin study (project number: P1309). These analyses used non-identified data only, and thus the current study was exempt from ethical review by the QUT Human Research Ethics Committee (exemption number 1600000095).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.