Are some medicines so good they should be free? In diabetes, the answer may be yes

ho has never had a stroke.

"In our society, we often pay for health strategies that provide health benefits at a reasonable but added cost," says Rosen. "But this strategy goes even further: it saves lives and saves money. Removing patient financial barriers for ACE inhibitors prevents expensive and life-threatening complications, and improves quality of life. In so doing, patients pay less, Medicare pays less, and everyone wins. It's a virtual no-brainer."

Even if the availability of free ACE inhibitors didn't cause a major upswing in the use of the drugs by these patients, the strategy would still pay for itself, Rosen says.

"If only 7 percent more people started taking ACE inhibitors when they were offered at no cost, Medicare would still save money. The more people that take advantage of the no-cost drugs, the bigger the savings for Medicare over the long term. And of course, each patient has a lower risk of heart attack, stroke, or kidney failure."

The researchers ran the computer model many times, making changes each time in 38 different variables. Ninety percent of the time, they found that no-cost ACE inhibitors saved money; the other 10 percent of the time they were cost-effective -- costing less than $20,000 per QALY gained.

The authors also looked at costs and savings on a societal, rather than Medicare, level -- including patients' productivity and the cost of caregiving for people with health-related disability. The savings were even greater than Medicare savings alone.

If Medicare were able to purchase ACE inhibitors for all its diabetes patients at the same low cost that the Department of Defense pays, the government's lifetime savings on each patient would be even higher. And it would only take a 1.1 percent increase in patient use of ACE inhibitors to make the program cost-saving.

Rosen notes that the analysis doesn't even take into account more recent evidence that ACE inhibitors can also

Contact: Kara Gavin
University of Michigan Health System

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