(P-495) Persistence to Treatment After Percutaneous Coronary Intervention for Acute Coronary Syndrome Patients as a Cost-saving Opportunities in Indonesia

Background: Persistence to treatment is known to reduce acute coronary syndrome (ACS) disease morbidity and mortality substantially. As much as 13% of the Indonesia’s budget on national health insurance program was used for cardiovascular disease. There has been a lack of population-based studies that showed the cost saving opportunities of persistence to treatment in ACS patients undergoing percutaneous coronary syndrome (PCI).

Objectives: To investigate the estimated cost saving of persistence to treatment in patients with ACS after their first PCI

Methods: Hospital based, retrospective cohort study with 2 years follow-up was conducted with 367 patients. Patients were deemed as having persistence to treatment if the gap between prescriptions was ≤ 30 days. Persistence was assessed for cardiovascular drugs consist of antiplatelet drugs (WHO ATC code: B0A1C), lipid modifying agents (C10), and antihypertensive (C02, C03, C07, C08, C09). The main outcome is cost saving opportunities assessed by dividing the difference in total costs resulting from persistence to treatment with the difference in the proportion of major adverse cardiovascular events (MACE) prevented by treatment persistence. MACE defined as a composite of repeat PCI, myocardial infarction, or all-cause death.

Results: The study found that total costs incurred by persistent patients were significantly lower than non-persistent patients with antiplatelet (IDR 10,287,447.17 versus IDR 12,710,256.17), lipid modifying agents (IDR 9,535,209.76 versus IDR 15,933,959.28), and antihypertensive (IDR 9,557,163.06 versus IDR 13,388,341.78). Persistent use of antiplatelet drugs can prevent 1 MACE incident at a cost of IDR 433,858.18 when compared to the non-persistent group. Meanwhile, the persistent use of lipid modifying agents can prevent 1 MACE incident at a cost of Rp. 996,192.41 when compared to non-persistent drug use. Likewise with antihypertensive drugs. Persistent use of antihypertensive drugs can prevent 1 MACE incident at a cost of Rp. 578,341.41 when compared to non-persistent drug use.

Conclusions: Our study indicates that among ACS patients who underwent their first PCI, persistence to treatment of cardiovascular drugs (antiplatelet, lipid modifying agents, and antihypertensive) can contribute to cost savings in preventing 1 MACE event. These data will be useful for policymakers to reemphasize the important role of medication adherence in the management of ACS after PCI.