Allison B. Rosen, MD, MPH, ScD; Mary Beth Hamel, MD, MPH; Milton C. Weinstein, PhD; David M. Cutler, PhD; A. Mark Fendrick, MD; Sandeep Vijan, MD, MS
Acknowledgments: The authors thank Joseph Newhouse, PhD; Lisa Iezzoni, MD, MSc; and Peter Neumann, ScD, for their helpful suggestions on the design and conduct of the analyses. The authors also thank Gerard Anderson, PhD, for his assistance in obtaining Medicare expenditure estimates for individuals with diabetes.
Grant Support: Dr. Rosen was supported by an AHRQ Health Services Research Fellowship at the Harvard School of Public Health (grant 5 T32 HS00020-16). Additional funding was provided by the Primary Care Research Fund of Brigham and Women's Hospital, which had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Allison B. Rosen, MD, MPH, ScD, Division of General Medicine, University of Michigan Health Systems, 300 North Ingalls, Suite 7E10, Ann Arbor, MI 48109; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Rosen: Division of General Medicine, University of Michigan Health Systems, 300 North Ingalls, Suite 7E10, Ann Arbor, MI 48109.
Dr. Hamel: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
Dr. Weinstein: Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115.
Dr. Cutler: University Hall, Ground Floor North, Harvard University, Cambridge, MA 02138.
Dr. Fendrick: Division of General Medicine, University of Michigan Health Systems, 300 North Ingalls, Suite 7C27, Ann Arbor, MI 48109.
Dr. Vijan: Department of Health Services Research & Development, Ann Arbor Veterans Affairs Medical Center, PO Box 130170, Ann Arbor, MI 48113-0170.
Author Contributions: Conception and design: A.B. Rosen, M.B. Hamel, S. Vijan.
Analysis and interpretation of the data: A.B. Rosen, M.B. Hamel, S. Vijan.
Drafting of the article: A.B. Rosen, D.M. Cutler, S. Vijan.
Critical revision of the article for important intellectual content: A.B. Rosen, M.B. Hamel, M.C. Weinstein, D.M. Cutler, A.M. Fendrick, S. Vijan.
Final approval of the article: A.B. Rosen, M.B. Hamel, M.C. Weinstein, D.M. Cutler, A.M. Fendrick, S. Vijan.
Statistical expertise: A.B. Rosen, M.C. Weinstein, S. Vijan.
Obtaining of funding: A.B. Rosen.
Collection and assembly of data: A.B. Rosen.
Rosen AB, Hamel MB, Weinstein MC, Cutler DM, Fendrick AM, Vijan S. Cost-Effectiveness of Full Medicare Coverage of Angiotensin-Converting Enzyme Inhibitors for Beneficiaries with Diabetes. Ann Intern Med. 2005;143:89-99. doi: 10.7326/0003-4819-143-2-200507190-00007
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Published: Ann Intern Med. 2005;143(2):89-99.
Economic barriers may contribute to the underutilization of angiotensin-converting enzyme (ACE) inhibitors in patients with diabetes.
This analysis shows that the Medicare program could improve clinical outcomes and save money by providing full coverage of ACE inhibitors with no out-of-pocket expense for patients with diabetes. Clinical and economic benefits would exist even if full coverage only resulted in a modest increase (7.2%) in ACE inhibitor use.
Insurers should consider a policy of covering the entire cost of drugs that improve outcomes and lengthen life.
The prevalence of diabetes and its complications is increasing substantially in the United States (1-4). As the population ages and the number of elderly Medicare beneficiaries increases relative to the rest of the population, so will the number of elderly persons with diabetes and the share of national health expenditures allocated to complications of diabetes. Angiotensin-converting enzyme (ACE) inhibitors slow the progression of renal disease (5-12) and reduce cardiac morbidity and mortality (13-15) in individuals with diabetes. Despite ample clinical (5-15) and economic (16-18) evidence of benefit, ACE inhibitors are underused in elderly individuals with diabetes (19-23).
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Cardiology, Nephrology, Hypertension, Healthcare Delivery and Policy, Coronary Risk Factors.
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