Show Me the Money: Patients' Perspectives on a Decision Aid for Sacubitril/Valsartan Addressing Out-of-Pocket Cost.

Autor:	Dickert NW; Department of Medicine, Division of Cardiology, Emory University School of Medicine, ECCRI, Atlanta, GA (N.W.D., A.R.M., A.A.M., C.D.S.).; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (N.W.D.).; Emory Center for Ethics, Atlanta, GA (N.W.D.)., Mitchell AR; Department of Medicine, Division of Cardiology, Emory University School of Medicine, ECCRI, Atlanta, GA (N.W.D., A.R.M., A.A.M., C.D.S.)., Venechuk GE; Adult and Child Consortium for Outcomes Research and Delivery Science (G.E.V., D.D.M., K.J.P., L.A.A.), University of Colorado School of Medicine, Aurora.; Center for Demography of Health and Aging, University of Wisconsin-Madison (G.E.V.)., Matlock DD; Adult and Child Consortium for Outcomes Research and Delivery Science (G.E.V., D.D.M., K.J.P., L.A.A.), University of Colorado School of Medicine, Aurora.; Division of Geriatric Medicine (D.D.M.), University of Colorado School of Medicine, Aurora.; Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver (D.D.M.)., Moore MA; Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA (M.A.M.)., Morris AA; Department of Medicine, Division of Cardiology, Emory University School of Medicine, ECCRI, Atlanta, GA (N.W.D., A.R.M., A.A.M., C.D.S.)., Pierce KJ; Adult and Child Consortium for Outcomes Research and Delivery Science (G.E.V., D.D.M., K.J.P., L.A.A.), University of Colorado School of Medicine, Aurora., Speight CD; Department of Medicine, Division of Cardiology, Emory University School of Medicine, ECCRI, Atlanta, GA (N.W.D., A.R.M., A.A.M., C.D.S.)., Allen LA; Adult and Child Consortium for Outcomes Research and Delivery Science (G.E.V., D.D.M., K.J.P., L.A.A.), University of Colorado School of Medicine, Aurora.; Division of Cardiology (L.A.A.), University of Colorado School of Medicine, Aurora.
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2020 Dec; Vol. 13 (12), pp. e007070. Date of Electronic Publication: 2020 Dec 11.
DOI:	10.1161/CIRCOUTCOMES.120.007070
Abstrakt:	Background: Out-of-pocket medication costs for patients who have heart failure with reduced ejection fraction may be an important part of shared decision-making, but cost has generally been excluded from clinical discussions. This study reports patients' perspectives on a decision aid for sacubitril/valsartan that explicitly addresses out-of-pocket costs. Methods: Structured, in-depth interviews were conducted with 20 patients with heart failure with reduced ejection fraction from 2 medical centers to elicit their views on a publicly available decision aid for sacubitril/valsartan that explicitly incorporates considerations related to out-of-pocket costs. Qualitative descriptive analysis was conducted. Results: Key themes identified were general enthusiasm for decision aids for medication decisions, openness on the part of patients to incorporation of cost into decision-making and the decision aid, requests for greater specificity regarding patient-specific cost, and challenges communicating evidence of benefit in a way that allows patients to make cost-benefit analyses for themselves. Patients also raised questions regarding logistical challenges of incorporating a decision aid into the normal clinical and decision-making workflow. Conclusions: Patients were receptive to the inclusion of out-of-pocket cost as relevant in a decision aid for sacubitril/valsartan. Key challenges to effective integration of cost in these decisions include developing mechanisms for acquiring reliable patient-specific cost estimates and addressing patients' difficulties (and sometimes skepticism) applying trial evidence to their own situation. In addition, implementation strategies are important to develop to facilitate decision aid integration for routine medical decisions into clinic workflow.
Databáze:	MEDLINE
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