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POCKET-COST-HF: Are There Benefits to Cost-Informed Decision Making in Treating Patients With HFrEF?

Providing patients being treated for heart failure with reduced ejection fraction (HFrEF) with specific out-of-pocket (OOP) costs for multiple medication options at the time of the clinical encounter had “a modest but significant impact” on the proportion of encounters in which cost was discussed, said researchers presenting findings from the POCKET-COST-HF study Nov. 11 at AHA 2023. Current annual out-of-pocket (OOP) costs for patients with HFrEF and Medicare Part D coverage are more than $2,600 for the usual four-drug therapy, but overall OOP costs are not typically known by clinicians or patients, researchers said.

The study, which leveraged a platform based on the EPIC-HF checklist that was updated with currently approved medications, divided 147 patients into two groups. The first only received the medication checklist, while the second received the checklist that also included estimated OOP costs for higher-priced medications at the time of encounter. Nearly 70% of patients in both groups were male, more than 60% were White and more than 23% were Black/African American. Additionally, roughly 45% of patients in both groups were on Medicare Part D or Medicare Advantage plans, more than 30% had private insurance and more than 40% made less than $50,000 a year in total income.

The primary outcome, which was cost-informed decision-making, defined as the clinician or patient mentioning costs of HFrEF medication, occurred in 49% of encounters with the checklist only control group compared with 68% of encounters in the OOP cost group (p=0.021).

“These hypothesis-generating findings suggest cost disclosure may reduce ‘contingency planning’ and increase the extent to which patients are taking the medications decided upon,” said Neal W. Dickert, MD, PhD, FACC, in presenting the results. “Larger sample sizes and longer-term follow-up are needed to assess the impact of comprehensive OOP cost disclosure on medication choices, prescribing and adherence.” He also noted that further exploration is needed of novel emerging tools that can be embedded and used within electronic health record systems, along with optimal strategies for implementing these tools in practice.

Keywords: American Heart Association, AHA23

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