Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure.
Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure.
复制标题
DOI：
10.1161/jaha.121.023789
复制
发表时间：
2022-06-20
影响因子：
5.4
通讯作者：
Dickert, Neal W.
中科院分区：
文献类型：
--
作者：
Rao, Birju R.;Speight, Candace D.;Allen, Larry A.;Halpern, Scott D.;Ko, Yi-An;Matlock, Daniel D.;Moore, Miranda A.;Morris, Alanna A.;Scherer, Laura D.;Thomson, Mary C.;Ubel, Peter;Dickert, Neal W.
与血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂相比，沙库巴曲/缬沙坦可改善心力衰竭的健康结果，并降低射血分数，但其自付费用较高。成本的影响以及如何将成本纳入医疗决策都没有得到很好的研究。为了评估自付费用和新型成本启动干预措施对服用沙库巴曲/缬沙坦治疗射血分数降低的心力衰竭的意愿的影响，使用在线益普索知识小组对自我报告心脏病的参与者进行了调查。向参与者提供经过修改的 sacubitril/valsartan 决策辅助工具，然后在 3×2 析因设计中，随机分配到 3 个成本条件中的 1 个（10 美元、50 美元或 100 美元/月）和对照组或成本启动干预，定义为在了解 sacubitril/valsartan 的益处之前询问有关其财务状况的问题。在参与分析的 1013 名参与者中，85% 的受访者愿意以 10 美元的价格服用沙库巴曲/缬沙坦，62% 的受访者愿意以 50 美元的价格服用，33% 的受访者愿意以 100 美元的价格服用（P<0.0001）。在多变量逻辑回归模型中，参与者更有可能服用 10 美元与 100 美元的沙库巴曲/缬沙坦（优势比 [OR]，14.3 [95% CI，9.4–21.8]），以及 50 美元与 100 美元相比（OR，3.6 [95% CI，2.5-5.1]）。总体而言，与未考虑其财务状况的参与者相比，考虑成本的组的参与者更愿意服用沙库巴曲/缬沙坦（63% vs 56%，P=0.04）。成本条件和成本启动之间不存在统计上显着的交互作用。沙库巴曲/缬沙坦相对于血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的感知益处随着成本增加而减少，但不因成本启动而变化。沙库巴曲/缬沙坦常见的自付费用可能会影响个人服药的意愿，即使是在医生推荐的情况下也是如此。在了解药物之前让个人考虑个人财务状况会增加服用沙库巴曲/缬沙坦的意愿。
Sacubitril/valsartan improves health outcomes for heart failure with reduced ejection fraction relative to angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, but it carries higher out‐of‐pocket costs. Neither the impact of cost nor how to integrate cost into medical decisions is well studied. To evaluate the impact of out‐of‐pocket costs and a novel cost‐priming intervention on willingness to take sacubitril/valsartan for heart failure with reduced ejection fraction, participants with self‐reported heart disease were surveyed using the online Ipsos Knowledge Panel. Participants were presented with a modified decision aid for sacubitril/valsartan and then, in a 3×2 factorial design, randomly assigned to 1 of 3 cost conditions ($10, $50, or $100/month) and to a control group or cost‐priming intervention, defined by being asked questions about their financial situation before learning about the benefits of sacubitril/valsartan. Of the 1013 participants included in the analysis, 85% of respondents were willing to take sacubitril/valsartan at $10, 62% at $50, and 33% at $100 (P<0.0001). In a multivariable logistic regression model, participants were more likely to take sacubitril/valsartan at $10 versus $100 (odds ratio [OR], 14.3 [95% CI, 9.4–21.8]) and $50 compared with $100 (OR, 3.6 [95% CI, 2.5–5.1]). Overall, participants in the cost‐primed group were more willing to take sacubitril/valsartan than those not primed to consider their financial situation (63% versus 56%, P=0.04). There was no statistically significant interaction between cost conditions and cost priming. Perceived benefit of sacubitril/valsartan over angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers decreased as cost increased but did not vary by cost priming. Commonly encountered out‐of‐pocket costs of sacubitril/valsartan may impact individuals’ willingness to take the medication even when recommended by their physicians. Priming individuals to consider personal finances before learning about the drug increased willingness to take sacubitril/valsartan.