Impact of the cost of prescription drugs on clinical outcomes in indigent patients with heart disease

Study Objective. To measure the impact that economic relief for prescriptio n drugs to indigent patients with cardiovascular disease has on indicators of disease control. Design. Prospective cohort study Setting. University inner-city outpatient clinic. Patients. One hundred sixty-three indigent patients with heart disease who were uninsured or whose insurance plan did not provide prescription drug co verage and who had baseline data. Intervention. Patients were assisted in obtaining prescription drugs, free of charge, in an attempt to improve adherence to their drug regimens. Measurements and Main Results. The primary end point was to determine if ca rdiovascular outcome measures (i.e., international normalized ratio [INR], blood pressure, low-density lipoprotein [LDL] cholesterol, and hospitalizat ions) and drug adherence improved in all patients after 6 months of prescri ption assistance compared with a 6-month baseline period. In patients recei ving warfarin, mean INR increased from 2.44 +/- 0.64 at baseline to 2.61 +/ - 0.53 at 6 months (p <0.05). In patients with hypertension, mean blood pre ssure decreased from 138 +/- 20/80 +/- 11 mm Hg at baseline to 138 19/78 +/ - 12 mm Hg at 6 months (p <0.05 for diastolic blood pressure only). The mea n LDL level for patients on lipid-lowering drugs significantly decreased fr om 126 +/- 39 mg/dl at baseline to 108 +/- 38 mg/dl at 6 months (p <0.001). For each disease measure, the improved disease control seen at 6 months pe rsisted throughout 24 months of follow-up. Hospitalizations for the entire cohort decreased from 85 at baseline to 49 at 6 months. Patient drug adhere nce improved from 48.5% at baseline to 72.7% at 6 months (p <0.001). Conclusions. Drug adherence and clinical outcomes improved, and the number of hospitalizations declined when cardiovascular drugs were obtained for pa tients who could not afford to pay for them. Health care insurance plans th at do not provide coverage for cardiovascular prescription drugs may be mor e costly secondary to poor disease control and increased hospitalizations.