A program for laboratory monitoring of renin-angiotensin system drugs is cost-effective for certain high-risk patients
Patient safety studies of routine clinical practice show that most, but not all patients who are prescribed angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), are routinely monitored with laboratory tests. According to a new study, the costs of laboratory monitoring of all patients in routine clinical practice outweigh the potential savings (and quality of life benefits). Yet focusing monitoring, or obtaining routine labs on patients at high risk of adverse drug events (ADEs) from ACEI or ARB therapy—in this case, patients with chronic kidney disease (CKD)—was cost-saving with 95 percent certainty. The authors also found that at a cost per quality-adjusted life-year of $30,000, lab monitoring among patients with CKD was cost-effective. Such findings are important, because earlier research shows that a quarter of preventable adverse drug events are associated with inadequate monitoring, and nearly two-fifths of patients receiving a medicine that required laboratory monitoring did not get the recommended baseline testing.
When the researchers looked at data on patients in a large health maintenance organization who were new users of an ACEI or ARB, they found that the 1-year cumulative risk of an ADE was four times higher for patients with CKD than for the patients overall. The risk for patients with diabetes was elevated by half. Modeling the cost savings in these three groups for a laboratory monitoring program, only the patients with CKD were calculated to save costs at least 95 percent of the time.
The researchers used decision analysis to bring together data from a variety of sources to estimate costs and outcomes for the study. AHRQ's Healthcare Cost and Utilization Project was the source for costs for hospitalization and emergency department visits. Based on their findings, the researchers suggest that further studies examine the potential for laboratory monitoring of high-risk patients to reduce preventable ADEs and investigate methods to identify patients at high risk of preventable ADEs.
This study was funded in part by a grant from the Agency for Healthcare Research and Quality (HS10391) to the HMO Research Network Center for Education and Research on Therapeutics (CERT). For more information on the CERTs program, visit http://www.certs.hhs.gov.
More details are in "An economic evaluation of a laboratory monitoring program for renin-angiotensin system agents," by David H. Smith, R.Ph., Ph.D., Marsha A. Raebel, Pharm.D., Arnold Chan, M.D.,Sc.D., and others in the March/April 2011 Medical Decision Making 31(2), pp. 315-324.
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