Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this randomized controlled trial, medication vouchers were associated with a small increase in patient-reported persistence with P2Y12 inhibitors for patients who had suffered a myocardial infarction (MI).

2. Medication vouchers were not associated with reduced major adverse cardiovascular events (MACE) in these patients.

Evidence Rating Level: 1 (Excellent)

Study Rundown:

Antiplatelet therapy, such as with P2Y12 inhibitors, is recommended for up to 1 year after myocardial infarction (MI). However, inability to afford the medication is often cited as a significant barrier to medication adherence. In this randomized controlled trial, patients with MI who received vouchers for a P2Y12 inhibitor had a slight increase in patient-reported medication persistence. However, there was no significant difference in 1-year major adverse cardiovascular events (MACE).

Overall, while this study suggests vouchers for P2Y12 inhibitors may not have a significant impact on cardiovascular health in post-MI patients, some limitations should be noted. For one, the study may not be generalizable to patients receiving P2Y12 inhibitors for other indications nor non-US populations. Further research is warranted in understanding the economics of providing vouchers as a public health intervention to improve outcomes.

In-Depth [randomized controlled trial]:

The Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study (ARTEMIS) was a multicenter and cluster randomized controlled trial that randomized 301 US hospitals, enrolling 11001 patients. Patients in the intervention group were given a voucher card for full payment prior to discharge that could be used to fill a generic (clopidogrel) or brand name (ticagrelor) P2Y12 inhibitor while patients in the control group did not receive a voucher. Persistence of P2Y12 inhibitor therapy and MACE, defined as the composite of all-cause death, recurrent MI, or stroke, at 1 year were the primary end points. Patient-reported persistence of P2Y12 therapy was higher in the voucher group (87.0% vs 83.8%, p < 0.001). However, there was no statistical difference in MACE at 1 year in both groups (10.2% vs 10.6%, p = 0.65).

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