Show Me the Money: Patients' Perspectives on a Decision Aid for Sacubitril/Valsartan Addressing Out-of-Pocket Cost.
Show Me the Money: Patients' Perspectives on a Decision Aid for Sacubitril/Valsartan Addressing Out-of-Pocket Cost.
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DOI：
10.1161/circoutcomes.120.007070
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Allen LA
中科院分区：
文献类型：
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作者：
Dickert NW;Mitchell AR;Venechuk GE;Matlock DD;Moore MA;Morris AA;Pierce KJ;Speight CD;Allen LA
补充数字内容可在文本中找到。射血分数降低的心力衰竭患者的自付药物费用可能是共同决策的重要组成部分，但费用通常被排除在临床讨论之外。本研究报告了患者对沙库巴曲/缬沙坦的决策辅助的观点，明确解决了自付费用。对来自2个医疗中心的20例射血分数降低的心力衰竭患者进行了结构化的深入访谈，以了解他们对公开可用的沙库比曲/缬沙坦决策辅助的看法，该决策辅助明确纳入了与自付费用相关的考虑因素。进行定性描述性分析。确定的关键主题是一般的热情，决策辅助药物的决策，开放的一部分，患者纳入成本决策和决策辅助，要求更具体的患者特定的成本，和挑战的沟通证据的好处的方式，让患者自己进行成本效益分析。患者还提出了关于将决策辅助纳入正常临床和决策工作流程的后勤挑战的问题。患者可以接受将自付费用纳入沙库比曲/缬沙坦的决策辅助中。在这些决策中有效整合成本的关键挑战包括开发获得可靠的患者特定成本估计的机制，以及解决患者将试验证据应用于自身情况的困难（有时是怀疑）。此外，实施策略是很重要的，以促进决策辅助集成到临床工作流程的常规医疗决策。
Supplemental Digital Content is available in the text. Out-of-pocket medication costs for patients who have heart failure with reduced ejection fraction may be an important part of shared decision-making, but cost has generally been excluded from clinical discussions. This study reports patients’ perspectives on a decision aid for sacubitril/valsartan that explicitly addresses out-of-pocket costs. Structured, in-depth interviews were conducted with 20 patients with heart failure with reduced ejection fraction from 2 medical centers to elicit their views on a publicly available decision aid for sacubitril/valsartan that explicitly incorporates considerations related to out-of-pocket costs. Qualitative descriptive analysis was conducted. Key themes identified were general enthusiasm for decision aids for medication decisions, openness on the part of patients to incorporation of cost into decision-making and the decision aid, requests for greater specificity regarding patient-specific cost, and challenges communicating evidence of benefit in a way that allows patients to make cost-benefit analyses for themselves. Patients also raised questions regarding logistical challenges of incorporating a decision aid into the normal clinical and decision-making workflow. Patients were receptive to the inclusion of out-of-pocket cost as relevant in a decision aid for sacubitril/valsartan. Key challenges to effective integration of cost in these decisions include developing mechanisms for acquiring reliable patient-specific cost estimates and addressing patients’ difficulties (and sometimes skepticism) applying trial evidence to their own situation. In addition, implementation strategies are important to develop to facilitate decision aid integration for routine medical decisions into clinic workflow.