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

Birju R Rao1, Candace D Speight1, Larry A Allen2

  • 1Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.

Journal of the American Heart Association
|June 20, 2022
PubMed

Insights

High out-of-pocket costs for sacubitril/valsartan significantly impact patient willingness to take this heart failure medication. Discussing finances before treatment increases patient acceptance.

Area of Science:

  • Cardiology
  • Health Economics
  • Behavioral Science

Background:

  • Sacubitril/valsartan offers improved outcomes for heart failure with reduced ejection fraction (HFrEF) compared to ACE inhibitors or ARBs.
  • Higher out-of-pocket costs for sacubitril/valsartan present a barrier to its adoption.
  • The influence of cost on treatment decisions and effective cost-integration strategies remain understudied.

Purpose of the Study:

  • To assess the impact of out-of-pocket costs on patient willingness to initiate sacubitril/valsartan for HFrEF.
  • To evaluate the effectiveness of a novel cost-priming intervention in influencing treatment acceptance.

Main Methods:

  • A survey of 1013 participants with self-reported heart disease was conducted using the Ipsos Knowledge Panel.
  • Participants were randomized in a 3x2 factorial design to three cost conditions ($10, $50, $100/month) and either a control or cost-priming intervention.
  • The cost-priming intervention involved financial situation inquiries before presenting drug benefits.

Main Results:

  • Willingness to take sacubitril/valsartan decreased significantly with increasing cost: 85% at $10, 62% at $50, and 33% at $100 (P<0.0001).
  • Patients were more likely to accept the drug at $10 vs $100 (OR, 14.3) and $50 vs $100 (OR, 3.6).
  • The cost-priming group showed higher willingness to take the medication (63% vs 56%, P=0.04), with no significant interaction effect.

Conclusions:

  • Out-of-pocket costs for sacubitril/valsartan can substantially influence patient adherence, even when medically indicated.
  • A cost-priming intervention, prompting financial consideration before learning about benefits, enhances willingness to accept sacubitril/valsartan.
  • Integrating cost considerations into patient decision-making may improve medication adherence for costly, high-benefit therapies.
Abstract

Keywords:
guideline‐directed medical therapyheart failureout‐of‐pocket cost

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