{"id":"9bbcc7e02505","type":"article","url":"https://hartvaat.nl/2019/01/01/medicatie-copay-vouchers-en-p2y12-gebruik-en-cv-events-na-mi-jama/","title":"Medicatie-copay vouchers en P2Y12-gebruik en CV-events na MI: JAMA","title_en":"Effect of Medication Co-payment Vouchers on P2Y12 Inhibitor Use and Major Adverse Cardiovascular Events Among Patients With Myocardial Infarction: The ARTEMIS Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2018.19791","source_url":"https://doi.org/10.1001/jama.2018.19791","authors":["Tracy Y Wang","Lisa A Kaltenbach","Christopher P Cannon","Gregg C Fonarow","Niteesh K Choudhry","Timothy D Henry","David J Cohen","Durgesh Bhandary","Naeem D Khan","Kevin J Anstrom","Eric D Peterson"],"significance":6,"published":"2019-01-01","source_date":"2019-01-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/"],"congress":"","summary_en":"This JAMA trial tested whether medication copayment vouchers for P2Y12 inhibitors improve adherence and cardiovascular outcomes after MI, addressing the financial barrier to guideline-recommended antiplatelet therapy.","created":"2026-07-03T10:27:41Z","updated":"2026-07-03T13:26:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA trial die onderzocht of copay vouchers voor P2Y12-remmers het medicatiegebruik en cardiovasculaire events verbeteren na MI. Financiële barrières en therapietrouw.","abstract_original":"IMPORTANCE: Despite guideline recommendations, many patients discontinue P2Y12 inhibitor therapy earlier than the recommended 1 year after myocardial infarction (MI), and higher-potency P2Y12 inhibitors are underutilized. Cost is frequently cited as an explanation for both of these observations. OBJECTIVE: To determine whether removing co-payment barriers increases P2Y12 inhibitor persistence and lowers risk of major adverse cardiovascular events (MACE). DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized clinical trial among 301 hospitals enrolling adult patients with acute MI (June 5, 2015, through September 30, 2016); patients were followed up for 1 year after discharge (final date of follow-up was October 23, 2017), with blinded adjudication of MACE; choice of P2Y12 inhibitor was per clinician discretion. INTERVENTIONS: Hospitals randomized to the intervention (n = 131 [6436 patients]) provided patients with co-payment vouchers for clopidogrel or ticagrelor for 1 year (median voucher value for a 30-day supply, $137 [25th-75th percentile, $20-$339]). Hospitals randomized to usual care (n = 156 [4565 patients]) did not provide study vouchers. MAIN OUTCOMES AND MEASURES: Independent coprimary outcomes were patient-reported persistence with P2Y12 inhibitor (defined as continued treatment without gap in use ≥30 days) and MACE (death, recurrent MI, or stroke) at 1 year among patients discharged with a prescription for clopidogrel or ticagrelor. RESULTS: Among 11 001 enrolled patients (median age, 62 years; 3459 [31%] women), 10 102 patients were discharged with prescriptions for clopidogrel or ticagrelor (clopidogrel prescribed to 2317 [36.0%] in the intervention group and 2497 [54.7%] in the usual care group), 4393 of 6135 patients (72%) in the intervention group used the voucher, and follow-up data at 1 year were available for 10 802 patients (98.2%). Patient-reported persistence with P2Y12 inhibitors at 1 year was higher in the intervention group than in the control group (unadjusted rates, 5340/6135 [87.0%] vs 3324/3967 [83.8%], respectively; P < .001; adjusted difference, 2.3% [95% CI, 0.4% to 4.1%]; adjusted odds ratio, 1.19 [95% CI, 1.02 to 1.40]). There was no significant difference in MACE at 1 year between intervention and usual care groups (unadjusted cumulative incidence, 10.2% vs 10.6%; P = .65; adjusted difference, 0.66% [95% CI, -0.73% to 2.06%]; adjusted hazard ratio, 1.07 [95% CI, 0.93 to 1.25]). CONCLUSIONS AND RELEVANCE: Among patients with MI, provision of vouchers to offset medication co-payments for P2Y12 inhibitors, compared with no vouchers, resulted in a 3.3% absolute increase in patient-reported persistence with P2Y12 inhibitors and no significant reduction in 1-year MACE outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02406677."}