WITHDRAWN Direct Medical Cost Associated With Antiplatelet Non-Persistence in Acute Coronary Syndrome Patients After Percutaneous Coronary Intervention

OBJECTIVES: To investigate the association between persistence to treatment with antiplatelet therapy and direct medical cost in patients presenting with the acute coronary syndrome (ACS) and undergoing percutaneous coronary intervention (PCI).

METHODS: This is a retrospective observational study carried out in five hospitals with PCI facilities in Indonesia between January 2019 and February 2020. A patient was defined as having non-persistence to treatment if there was a gap of more than 30 days without a refill for the same medication. Persistency was assessed for platelet aggregation inhibitors (WHO ATC Code: B01AC). Direct medical costs were collected based on the actual cost derived from billing data in outpatient and inpatient units. This includes administration, cost of medication, consumable medical supplies, cost of invasive treatments, laboratory tests, accommodation, doctor consultation, and other health professional consulting services.

RESULTS: A total of 367 patients were recruited. Of these, 267 patients had complete billing data available for cost analysis with 202 (75.6%) persistence and 65 (24.4%) non-persistence to antiplatelet therapy. Average cost of medication were IDR 3,522,741 (USD 237.54) in the persistence group compared with IDR 5,526,641 (USD 372.71) in the non-persistence group (p=0.02). Total direct medical cost in persistence group was significantly smaller than non-persistence group [IDR 10,287,447 (USD 693.77) versus IDR 12,710,256 (USD 857.16); p=0.02]. The higher total direct medical cost was significantly associated (p<0.05) with older age (≥ 59 years), being male, admitted to the hospital with referral, hospital bills paid by the national health insurance, having a history of cardiovascular diseases, hypertension, and diabetes.

CONCLUSIONS: This study indicates non-persistence of antiplatelet therapy among ACS patients after PCI was associated with higher cost of medication and higher total direct medical cost. Higher total direct medical costs for ACS patients after PCI were influenced by their comorbidities, namely hypertension and diabetes.