Deciding Whether to Take Sacubitril/Valsartan: How Cardiologists and Patients Discuss Out-of-Pocket Costs.
Deciding Whether to Take Sacubitril/Valsartan: How Cardiologists and Patients Discuss Out-of-Pocket Costs.
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DOI：
10.1161/jaha.122.028278
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发表时间：
2023-04-04
影响因子：
5.4
通讯作者：
Ubel, Peter A.
中科院分区：
文献类型：
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作者：
Rao, Birju R.;Akrobetu, Dennis J.;Dickert, Neal W.;Nguyen, Thuy-Vi;Davis, J. Kelly;Campagna, Ada;Mitchell, Andrea R.;Sharma, Anu;Speight, Candace D.;Barks, Mary Carol;Farley, Samantha;Gutterman, Sophia;Santanam, Taruni;Ubel, Peter A.
自付费用对心力衰竭患者有重大影响，理想情况下应纳入临床护理的共同决策。高昂的自付费用是新指南指导的治疗心力衰竭伴射血分数降低的药物疗法应用缓慢的一个潜在原因。本研究旨在描述患者与心脏病专家在批准后早期讨论与苏比里尔/缬沙坦相关的自付费用。我们对2015年至2018年期间发生的222次门诊录音记录进行了内容分析，其中心脏病专家（n=16）及其患者讨论了是否开始、继续或停止使用苏比里尔/缬沙坦。在纳入的222次会面中，100次（45%）讨论了成本问题。在各种情况下讨论了成本：何时开始使用苏比里尔/缬沙坦，何时未开始使用，何时继续使用，何时停药。在分析的97次成本对话中，大多数涉及关于保险范围的孤立讨论（64/97次会面；66%），很少涉及具体的自付成本或可负担性（28/97次会面；29%）。讨论sacubitril/缬沙坦的免费样品是常见的（52/97次接触；54%），通常没有讨论解决成本的长期计划。虽然在讨论苏比里尔/缬沙坦的患者-心脏病专家会面中，成本对话有些常见，但这些对话通常是肤浅的，很少涉及可负担性或成本价值判断。心脏病专家经常向患者提供一个疗程的免费苏比里尔/缬沙坦样本，而没有计划在样本用完后解决成本问题。
Out‐of‐pocket costs have significant implications for patients with heart failure and should ideally be incorporated into shared decision‐making for clinical care. High out‐of‐pocket cost is one potential reason for the slow uptake of newer guideline‐directed medical therapies for heart failure with reduced ejection fraction. This study aims to characterize patient–cardiologist discussions involving out‐of‐pocket costs associated with sacubitril/valsartan during the early postapproval period. We conducted content analysis on 222 deidentified transcripts of audio‐recorded outpatient encounters taking place between 2015 and 2018 in which cardiologists (n=16) and their patients discussed whether to initiate, continue, or discontinue sacubitril/valsartan. In the 222 included encounters, 100 (45%) contained discussions about cost. Cost was discussed in a variety of contexts: when sacubitril/valsartan was initiated, not initiated, continued, and discontinued. Of the 97 cost conversations analyzed, the majority involved isolated discussions about insurance coverage (64/97 encounters; 66%) and few addressed specific out‐of‐pocket costs or affordability (28/97 encounters; 29%). Discussion of free samples of sacubitril/valsartan was common (52/97 encounters; 54%), often with no discussion of a longer‐term plan for addressing cost. Although cost conversations were somewhat common in patient–cardiologist encounters in which sacubitril/valsartan was discussed, these conversations were generally superficial, rarely addressing affordability or cost‐value judgments. Cardiologists frequently provided patients with a course of free sacubitril/valsartan samples without a plan to address the cost after the samples ran out.