1 research outputs found
Deciding Whether to Take Sacubitril/Valsartan: How Cardiologists and Patients Discuss OutâofâPocket Costs
Background Outâofâpocket costs have significant implications for patients with heart failure and should ideally be incorporated into shared decisionâmaking for clinical care. High outâofâpocket cost is one potential reason for the slow uptake of newer guidelineâdirected medical therapies for heart failure with reduced ejection fraction. This study aims to characterize patientâcardiologist discussions involving outâofâpocket costs associated with sacubitril/valsartan during the early postapproval period. Methods and Results We conducted content analysis on 222 deidentified transcripts of audioârecorded 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 outâofâpocket 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 longerâterm plan for addressing cost. Conclusions Although cost conversations were somewhat common in patientâcardiologist encounters in which sacubitril/valsartan was discussed, these conversations were generally superficial, rarely addressing affordability or costâvalue 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