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Shen Q, Chua DCW, Chan PF, Wee HL. Development of a decision aid with cost information for heart failure medication in Singapore. PEC INNOVATION 2024; 5:100342. [PMID: 39290457 PMCID: PMC11407231 DOI: 10.1016/j.pecinn.2024.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 08/09/2024] [Accepted: 08/31/2024] [Indexed: 09/19/2024]
Abstract
Objective This study presents the development process of a heart failure (HF) medication decision aid (DA) specific to Singapore context, with the objective of promoting cost conversations. Methods Phase 1 was to create a DA prototype, where two HF clinicians were consulted on their input and needs. Phase 2 was pilot testing where the prototype was tested on HF patients and revised based on their feedback. Results The DA is a one-page poster that compares only two classes of HF medications. It encompasses seven attributes for comparison, including route of administration, treatment duration, frequency of use, hospitalization rate, survival rate, low blood pressure probability with personalized subsidized cost being the key attribute. A total of 48 patients participated in the pilot testing with only 2 patients (4.2 %) finding the DA difficult to understand. Almost all patients agreed that the DA provided greater clarity in the medication options. Conclusion By integrating the needs of both clinicians and patients and conducting user testing, we developed a novel HF medication DA. Patients found the tool easy to understand and acceptable. Innovation This innovative DA aims to improve cost conversations by providing tailored, concise, and locally relevant information for efficient use.
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Affiliation(s)
- Qianyu Shen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Po Fun Chan
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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2
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Allen LA, Lowe EF, Matlock DD. The Economic Burden of Heart Failure with Reduced Ejection Fraction: Living Longer but Poorer? Heart Fail Clin 2024; 20:363-372. [PMID: 39216922 DOI: 10.1016/j.hfc.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Treatment of heart failure with reduced ejection fraction (HFrEF) has benefitted from a proliferation of new medications and devices. These treatments carry important clinical benefits, but also come with costs relevant to payers, providers, and patients. Patient out-of-pocket costs have been implicated in the avoidance of medical care, nonadherence to medications, and the exacerbation of health care disparities. In the absence of major health care policy and payment redesign, high-quality HFrEF care delivery requires transparent integration of cost considerations into system design, patient-clinician interactions, and medical decision making.
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Affiliation(s)
- Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Academic Office One, #7019, Mailstop B130, Aurora, CO 80045, USA.
| | - Emily Fryman Lowe
- Department of Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Mailstop B177, Aurora, CO 80045, USA
| | - Dan D Matlock
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Children's Hospital Colorado, 1890 North Revere Court, Mailstop F44, Aurora, CO 80045, USA
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Gunn AH, Warraich HJ, Mentz RJ. Costs of care and financial hardship among patients with heart failure. Am Heart J 2024; 269:94-107. [PMID: 38065330 DOI: 10.1016/j.ahj.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/17/2023] [Accepted: 12/02/2023] [Indexed: 01/09/2024]
Abstract
With the implementation of new therapies, more patients are living with heart failure (HF) as a chronic condition. Alongside these advances, out-of-pocket (OOP) medical costs have increased, and patients experience significant financial burden. Despite increasing interest in understanding and mitigating financial burdens, there is a relative paucity of data specific to HF. Here, we explore financial hardship in HF from the patient perspective, including estimated OOP costs for guideline-directed medical therapy for HF with reduced ejection fraction, hospitalizations, and total direct medical costs, as well as the consequences of high OOP costs. Studies estimate that high OOP costs are common in HF, and a large proportion are related to prescription drugs. Subsequently, the effects on patients can lead to worsening adherence, delayed care, and poor outcomes, leading to a financial toxicity spiral. Further, we summarize patients' cost preferences and outline future research that is needed to develop evidence-based solutions to reduce costs in HF.
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Affiliation(s)
- Alexander H Gunn
- Department of Medicine, Duke University School of Medicine, Durham, NC.
| | - Haider J Warraich
- Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, MA
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
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Salahuddin T, Hebbe A, Daus M, Essien UR, Waldo SW, Rodriguez F, Ho PM, Simons C, Gilmartin HM, Doll JA. Trends and site-level variation of novel cardiovascular medication utilization among patients admitted for heart failure or coronary artery disease in the US Veterans Affairs System: 2017-2021. Am Heart J 2024; 268:68-79. [PMID: 37956920 DOI: 10.1016/j.ahj.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/18/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND We assessed trends in novel cardiovascular medication utilization in US Veterans Affairs (VA) for angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 Inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA). METHODS We retrospectively identified cohorts from 114 VA hospitals with admission for prevalent 1) systolic heart failure (HF, N = 82,375) or 2) coronary artery disease and diabetes (CAD+T2D, N = 74,209). Site-level data for prevalent filled prescriptions were assessed at hospital admission, discharge, or within 6 months of discharge. Variability among sites was estimated with median odds ratios (mOR), and within-site Pearson correlations of utilization of each medication class were calculated. Site- and patient-level characteristics were compared by high-, mixed-, and low-utilizing sites. RESULTS ARNI and SGTL2i use for HF increased from <5% to 20% and 21%, respectively, while SGTL2i or GLP-1 RA use for CAD+T2D increased from <5% to 30% from 2017 to 2021. Adjusted mOR and 95% confidence intervals for ARNI, SGTL2i for HF, and SGTL2i or GLP-1 RA for CAD+T2D were 1.73 (1.64-1.91), 1.72 (1.59-1.81), and 1.53 (1.45-1.62), respectively. Utilization of each medication class correlated poorly with use of other novel classes (Pearson <0.38 for all). Higher patient volume, number of beds, and hospital complexity correlated with high-utilizing sites. CONCLUSIONS Utilization of novel medications has increased over time but remains suboptimal for US Veterans with HF and CAD+T2D, with substantial site-level heterogeneity despite a universal medication formulary and low out-of-pocket costs for patients. Future work should include further characterization of hospital- and clinician-level practice patterns to serve as targets to increase implementation.
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Affiliation(s)
- Taufiq Salahuddin
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA; VA Puget Sound Health Care System, Seattle, WA; Seattle-Denver Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, CO
| | - Annika Hebbe
- VA Puget Sound Health Care System, Seattle, WA; Seattle-Denver Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, CO; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
| | - Marguerite Daus
- VA Puget Sound Health Care System, Seattle, WA; Seattle-Denver Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, CO; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO
| | - Utibe R Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA; Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA
| | - Stephen W Waldo
- VA Puget Sound Health Care System, Seattle, WA; Seattle-Denver Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, CO; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA
| | - P Michael Ho
- VA Puget Sound Health Care System, Seattle, WA; Seattle-Denver Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, CO
| | - Carol Simons
- VA Puget Sound Health Care System, Seattle, WA; Seattle-Denver Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, CO
| | - Heather M Gilmartin
- VA Puget Sound Health Care System, Seattle, WA; Seattle-Denver Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, CO; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO; Department of Health Systems, Management and Policy, University of Colorado School of Public Health, Aurora, CO
| | - Jacob A Doll
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA; VA Puget Sound Health Care System, Seattle, WA; Seattle-Denver Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, CO; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC.
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Amin K, Bethel G, Jackson LR, Essien UR, Sloan CE. Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity. Curr Atheroscler Rep 2023; 25:1113-1127. [PMID: 38108997 PMCID: PMC11044811 DOI: 10.1007/s11883-023-01180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW Pharmacoequity refers to the goal of ensuring that all patients have access to high-quality medications, regardless of their race, ethnicity, gender, or other characteristics. The goal of this article is to review current evidence on disparities in access to cardiovascular drug therapies across sociodemographic subgroups, with a focus on heart failure, atrial fibrillation, and dyslipidemia. RECENT FINDINGS Considerable and consistent disparities to life-prolonging heart failure, atrial fibrillation, and dyslipidemia medications exist in clinical trial representation, access to specialist care, prescription of guideline-based therapy, drug affordability, and pharmacy accessibility across racial, ethnic, gender, and other sociodemographic subgroups. Researchers, health systems, and policy makers can take steps to improve pharmacoequity by diversifying clinical trial enrollment, increasing access to inpatient and outpatient cardiology care, nudging clinicians to increase prescription of guideline-directed medical therapy, and pursuing system-level reforms to improve drug access and affordability.
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Affiliation(s)
- Krunal Amin
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Garrett Bethel
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Utibe R Essien
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Caroline E Sloan
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
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Allen LA, Lowe EF, Matlock DD. The Economic Burden of Heart Failure with Reduced Ejection Fraction: Living Longer but Poorer? Cardiol Clin 2023; 41:501-510. [PMID: 37743073 DOI: 10.1016/j.ccl.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Treatment of heart failure with reduced ejection fraction (HFrEF) has benefitted from a proliferation of new medications and devices. These treatments carry important clinical benefits, but also come with costs relevant to payers, providers, and patients. Patient out-of-pocket costs have been implicated in the avoidance of medical care, nonadherence to medications, and the exacerbation of health care disparities. In the absence of major health care policy and payment redesign, high-quality HFrEF care delivery requires transparent integration of cost considerations into system design, patient-clinician interactions, and medical decision making.
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Affiliation(s)
- Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Academic Office One, #7019, Mailstop B130, Aurora, CO 80045, USA.
| | - Emily Fryman Lowe
- Department of Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Mailstop B177, Aurora, CO 80045, USA
| | - Dan D Matlock
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Children's Hospital Colorado, 1890 North Revere Court, Mailstop F44, Aurora, CO 80045, USA
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