(B-167) Antihypertensive Treatment Persistence and Direct Medical Cost in Acute Coronary Syndrome Patients Post-Percutaneous Coronary Intervention: Insights from Indonesia

Background: Non-persistence to antihypertensive therapy in patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI) may lead to an increased economic burden.

Objectives: To evaluate the association between persistence to antihypertensive treatment and direct medical costs in ACS patients post-PCI.

Methods: An observational retrospective cohort study was conducted across five PCI-capable hospitals in Indonesia from January 2019 to February 2020. Non-persistence to antihypertensive therapy was defined as a medication gap exceeding 30 days without a refill. Treatment persistence was evaluated for antihypertensive medicines classified under WHO ATC codes C02, C03, C07, C08, and C09. Direct medical costs were extracted from hospital billing records for both outpatient and inpatient services, covering administration, medications, consumables medical supplies, cost of invasive procedures, laboratory tests, accommodation, doctor consultation, and other health professional consulting services.

Results: Of the 367 included patients, 267 patients had complete billing data for analysis. Among these, 175 (65.5%) were classified as persistence, while 92 (34.5%) were non-persistence to antihypertensive therapy. The average cost of medication was significantly lower in the persistence group compared to the non-persistence group [IDR 3,379,526 (USD 206.86) versus IDR 5,210,846 (USD 318.96); p< 0.001]. Additionally, the average total direct medical cost in persistence group was significantly lower than non-persistence group [IDR 9,557,163 (USD 584.99) versus IDR 13,388,341 (USD 819.50); p< 0.001]. The higher total direct medical cost was significantly associated (p < 0.05) with older age (≥ 59 years), referral-based hospital admission, emergency unit visits, and a history of hypertension.

Conclusions: The findings suggest that ACS patients post-PCI who are non-persistent to antihypertensive treatment are associated with significantly higher direct medical costs, especially in terms of total costs and medication costs. Factors such as older age, hospital admission through referral, emergency unit visits, and a history of hypertension contribute to increased direct medical costs in this patient population.