High-deductible health plan (HDHP) effects on major cardiovascular outcomes are unknown. We studied a 2004-2014 national sample of 63,363 HDHP members aged 40-64 years with diabetes, cardiovascular disease, hypertension, or hyperlipidemia, who were continuously enrolled for 1 year in a low-deductible (≤$500) plan followed by 3 years in a HDHP (≥$1000) after an employer-mandated switch. We matched HDHP members to 539,445 contemporaneous controls who had the same cardiovascular risk factors and whose employers offered only low-deductible plans. Using a controlled interrupted-time-series design, we analyzed cumulative rates of myocardial infarction, stroke, and amputation. We modelled weighted cumulative event rates using aggregate-level segmented regression. HDHP members experienced no detectable absolute change in myocardial infarction (-0.9 events per 10,000 members, 95% confidence interval: -2.7, 0.8) at 3 years of follow-up relative to the end of the baseline year compared to controls. Stroke and amputation declined by 3.4 (-4.0, -2.9) and 6.7 (-9.0, -4.4) events per 10,000 members, respectively, among HDHP members versus controls over the same period. At-risk patients who were switched to HDHPs did not experience increases in major cardiovascular outcomes over 3 follow-up years. Future research should follow patients longer and examine outcomes among low-income populations.
J. Wharam: None. F. Zhang: None. C. Lu: None. A.F. Hernandez: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc., Novartis Pharmaceuticals Corporation. Research Support; Self; AstraZeneca, GlaxoSmithKline plc., Merck & Co., Inc., Novartis Pharmaceuticals Corporation. J. Wallace: None. D. Ross-Degnan: None. J.P. Newhouse: Board Member; Self; Aetna Inc.
National Institutes of Health