Adoption of Sacubitril/Valsartan for the Management of Patients With Heart Failure
Adoption of Sacubitril/Valsartan for the Management of Patients With Heart Failure
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DOI：
10.1161/circheartfailure.117.004302
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发表时间：
2018-02-01
影响因子：
9.7
通讯作者：
Dunlay, Shannon M.
中科院分区：
文献类型：
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作者：
Sangaralingham, Lindsey R.;Sangaralingham, S. Jeson;Dunlay, Shannon M.
背景：美国食品和药物管理局于 2015 年 7 月批准在射血分数降低的心力衰竭患者中使用沙库巴曲/缬沙坦。我们的目的是评估美国食品和药物管理局批准后的前 18 个月内沙库巴曲/缬沙坦的采用情况和处方药成本。方法和结果：利用美国大型保险数据库，我们确定了为以下疾病配药的私人保险和 Medicare Advantage 受益人： 2015年7月1日至2016年12月31日期间使用沙库巴曲/缬沙坦。我们将他们与接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗的患者进行了比较。结果包括采用、处方药费用和 180 天的坚持（定义为覆盖天数比例 >= 80%）。共有 2244 名患者接受了沙库巴曲/缬沙坦治疗。尽管使用者数量随着时间的推移而增加，但服用沙库巴曲/缬沙坦的射血分数降低的心力衰竭患者的比例仍然很低（< 3%）。与服用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的患者相比，服用沙库巴曲/缬沙坦的患者更年轻，男性居多，合并症更少。尽管大部分处方费用由健康计划承担（平均每 30 天处方 328.37 美元；中位数为 362.44 美元），自付费用仍然很高（平均为 71.16 美元；中位数为 40.27 美元）。相比之下，赖诺普利、氯沙坦、卡维地洛和螺内酯的自付费用中位数为 2 至 3 美元。总体而言，59.1% 的患者坚持使用沙库巴曲/缬沙坦。补充模式表明，近一半的非依从性患者在开始使用后 180 天内停用沙库巴曲/缬沙坦。结论：美国食品和药物管理局批准后，沙库巴曲/缬沙坦的采用进展缓慢，可能与高成本有关。
BACKGROUND: The US Food and Drug Administration approved the use of sacubitril/valsartan in patients with heart failure with reduced ejection fraction in July 2015. We aimed to assess the adoption and prescription drug costs of sacubitril/valsartan in its first 18 months after Food and Drug Administration approval.METHODS AND RESULTS: Using a large US insurance database, we identified privately insured and Medicare Advantage beneficiaries who filled a first prescription for sacubitril/valsartan between July 1, 2015, and December 31, 2016. We compared them to patients treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Outcomes included adoption, prescription drug costs, and 180-day adherence, defined as a proportion of days covered >= 80%. A total of 2244 patients initiated sacubitril/valsartan. Although the number of users increased over time, the proportion of heart failure with reduced ejection fraction patients taking sacubitril/valsartan remained low (< 3%). Patients prescribed sacubitril/valsartan were younger, more often male, with less comorbidity than those taking an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Although a majority of prescription costs were covered by the health plan (mean, $328.37; median, $362.44 per 30-day prescription), out-of-pocket costs were still high (mean, $71.16; median, $40.27). By comparison, median out-of-pocket costs were $2 to $3 for lisinopril, losartan, carvedilol, and spironolactone. Overall, 59.1% of patients were adherent to sacubitril/valsartan. Refill patterns suggested that nearly half of nonadherent patients discontinued sacubitril/valsartan within 180 days of starting.CONCLUSIONS: Adoption of sacubitril/valsartan after Food and Drug Administration approval has been slow and may be associated with the high cost.