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Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure

BACKGROUND: 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 medic...

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Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238635/
https://www.ncbi.nlm.nih.gov/pubmed/35723002
http://dx.doi.org/10.1161/JAHA.121.023789
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author 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.
author_facet 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.
author_sort Rao, Birju R.
collection PubMed
description BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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.
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spelling pubmed-92386352022-06-30 Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure 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. J Am Heart Assoc Original Research BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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. John Wiley and Sons Inc. 2022-06-20 /pmc/articles/PMC9238635/ /pubmed/35723002 http://dx.doi.org/10.1161/JAHA.121.023789 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
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.
Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure
title Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure
title_full Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure
title_fullStr Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure
title_full_unstemmed Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure
title_short Impact of Financial Considerations on Willingness to Take Sacubitril/Valsartan for Heart Failure
title_sort impact of financial considerations on willingness to take sacubitril/valsartan for heart failure
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238635/
https://www.ncbi.nlm.nih.gov/pubmed/35723002
http://dx.doi.org/10.1161/JAHA.121.023789
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