Low income tied to less sacubitril/valsartan adherence in patients with HFrEF
Patients with HF with reduced ejection fraction and lower household income were less likely to file a prescription for sacubitril/valsartan and were less adherent to treatment compared with higher-income patients, researchers reported.
At the American Heart Association Quality of Care and Outcomes Research Scientific Sessions, researchers presented evidence that patients with HFrEF and income of less than $40,000 per year were nearly 30% less likely to fill their prescriptions for sacubitril/valsartan (Entresto, Novartis) compared with patients with HFrEF making at least $100,000 per year.
The findings were simultaneously published in Circulation: Cardiovascular Quality and Outcomes.
“Shortly after FDA approval of sacubitril/valsartan, many insurance companies provided limited coverage with high co-pays of hundreds of dollars per month. Although Medicare and some private insurance companies now cover the drug with copays of $1 to $10 per month, patient income may continue to serve as a barrier to utilization and adherence,” Amber E. Johnson, MD, MS, MBA, assistant professor of medicine at the University of Pittsburgh School of Medicine and staff physician at the VA Pittsburgh Health System, and colleagues wrote in the simultaneous publication. “Medication adherence is associated with events and health care costs in individuals with HFrEF. Proportion of days covered (PDC) is a validated measure of medication prescription and adherence, but proportion of days covered data for patients with HF who take sacubitril/valsartan remain scarce.”
To better understand the factors associated with sacubitril/valsartan utilization, researchers analyzed 135,282 patients with HFrEF who had at least 6 months of continuous follow-up (mean age, 75 years; 2.3% Asian; 14.7% Black; 9.7% Hispanic; 71.2% white; 44.5% women) and were included in the Optum de-identified Clinformatics Data Mart.
Sacubitril/valsartan prescription was defined as presence of a claim within 6 months of HFrEF diagnosis. Adherence was defined as a proportion of days covered of at least 80%.
More than 37% of the overall cohort had a household income of less than $40,000 per year.
Higher income was more common among Asian and white patients with HFrEF, whereas Black and Hispanic patients more often had lower income.
Overall, 4.7% of patients with HFrEF included in the analysis had a claim for sacubitril/valsartan within 6 months of HFrEF diagnosis.
Researchers reported that individuals with less than $40,000 in household income per year were approximately 17% less likely to have a claim for sacubitril/valsartan within 6 months of HFrEF diagnosis compared with patients in highest income category, defined as at least $100,000 per year (OR = 0.83; 95% CI, 0.76-0.9).
Moreover, annual income of less than $40,000 was associated with lower odds of sacubitril/valsartan adherence (proportion of days covered of more than 80%) compared with annual income of at least $100,000 (OR = 0.7; 95% CI, 0.59-0.83).
“Prescription medication costs are the largest contributor to outpatient cardiovascular expense. Yet, patients report that their physicians are unaware of the cost of the medications they prescribe, despite discussions of cost being important as part of shared decision-making,” the researchers wrote. “Fortunately, sacubitril/valsartan has been found to be cost-effective over the long run. Though the cost of sacubitril/valsartan far exceeds generic options, cost savings are projected to stem from prevention of HF hospitalizations, increased life expectancy and improved quality of life. Moreover, the cost of sacubitril/valsartan may decrease in 2023 after its patent expires.”
Reference:
Collapse
Johnson A, et al. Presentation 185. Presented at: American Heart Association Quality of Care and Outcomes Research Scientific Sessions; May 13-14, 2022; Reston, Va. (hybrid meeting).