Blood pressure-lowering drugs are among the best weapons available for preventing life-threatening complications in patients with diabetes, yet far too few of those patients take them.
Cost is believed to be a big deterrent to ACE inhibitor use, especially among older people who often have numerous chronic medical problems and take many other medications. Now a new study suggests that we would all save money if the 8 million people with diabetes in the U.S. over the age of 65 got the drugs for free.
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Lowering blood pressure with medications has been shown to reduce the risk of heart disease, which is the major cause of death in people with diabetes. According to the American Diabetes Association, people with diabetes have a twofold to fourfold increase in the risk of dying from complications of heart disease.
Researchers concluded that giving ACE inhibitors to older people with diabetes would financially benefit the Medicare system and society at large. The blood pressure lowering drugs prevent costly heart attacks, strokes, and kidney failure in these high-risk patients. People with diabetes should be treated to attain a blood pressure of less than 130/80.
The cost analysis of the researchers was published in the July 19 issue of the Annals of Internal Medicine.
"Giving ACE inhibitors to older diabetics at no cost is really a win-win situation," researcher Allison B. Rosen, MD, MPH, tells WebMD. "Ensuring that the people who will benefit most are on the medications that will help save their lives is not just good for the patients, it is good for the bottom line in terms of getting the most value for our health care dollar."
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Calculating the Costs
Rosen's research comes as federal officials are set to implement the Medicare prescription drug coverage plan, which will pay some of the drug costs for the elderly and disabled.
Even though ACE inhibitors are relatively cheap — with generic versions of the drugs costing patients around $250 a year — Rosen says study after study has shown that even small out-of-pocket expenses keep many people from taking the drugs they need.
Rosen and colleagues came up with a computer model that calculated the costs of the blood pressure drugs and the benefits derived from them and the costs of diabetes-related complications among patients over the age of 65.
They concluded that even once the new government co-pay goes into effect, Medicare would save roughly $900 per recipient if ACE inhibitors were given to people with diabetes over the age of 65.
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Good for Society
More than 200,000 Americans die each year due to complications from diabetes. The economic cost of diabetes was roughly $132 billion in the U.S. in 2002, or one out of every 10 health care dollars spent, according to the American Diabetes Association.
A person with diabetes has the same risk of having a heart attack and stroke as someone who has already had a heart attack. More than 65 percent of people with diabetes will die of heart disease or stroke, and they are likely to die younger than people who do not have the disease.
American Diabetes Association president Robert Rizza, MD, tells WebMD that the new research shows that making the right medications available to all people with diabetes will save society money in the long run.
"It is clear that it is cheaper to prevent complications from diabetes than to pay to treat these complications," he says. "It is certainly better for society in terms of human suffering and quality of life for diabetics to have access to these drugs, and this study shows that it is actually cheaper as well."
In addition to ACE inhibitors, many other drugs have been shown to be effective for preventing the life-threatening complications of diabetes. They include medications to control blood sugars, cholesterol-lowering statins, and low-dose aspirin therapy when indicated.
Yet, studies make it clear that far too few people with diabetes are taking the preventive medications that they need.
"Even in the best situations, only a portion of the people who would benefit from these drugs are using them," Rizza says.
While cost is an obstacle, so is education, says Rizza.
"We still have to get the message out so that both health care providers and patients know the impact that these drugs can have," he says.
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SOURCES: Rosen, A.B. Annals of Internal Medicine, July 19, 2005; vol 143: online edition. Allison B. Rosen, MD, MPH, ScD, assistant professor in general medicine, health management and policy, University of Michigan Health Systems, Ann Arbor, Mich. Robert Rizza, MD, president, American Diabetes Association; professor of medicine, division of endocrinology, diabetes, nutrition and metabolism, Mayo Clinic College of Medicine, Rochester, Minn.