Patient Paid Healthcare Costs Following Initiation with Sacubitril/Valsartan in a Retrospective Claims-Based Study

Background Total direct and indirect cost for HF is expected to more than double between 2012 and 2030; however, little is known how new therapies, such as sacubitril/valsartan (S/V), may impact patient (pt) paid costs. Objective To compare pt paid healthcare costs in the 3 months pre- and post-S/V initiation. Methods Using de-identified claims data from a large US managed care health plan, we identified adults with first S/V pharmacy claim during Oct 2015 to Jun 2016. Heart failure-related medication utilization and pt paid healthcare costs in 3-month pre- and post-index periods were calculated. Medication fills and costs were compared between periods using McNemar and paired t-tests. Results A total of 606 pts treated with S/V were identified: mean (SD) age, 68.6 (12.7) years; 77.7% Medicare Advantage enrollee; 67.8% male; 76.6% shortness of breath; 71.6% ischemic heart disease (other than MI); 33.0% renal disease; 25.9% sleep apnea; 22.9% edema and fluid overload. During the 3-month post-index period, pts experienced 2.6 (1.1) mean (SD) S/V fills, 54.8% of pts filled index S/V dose of ≤24/26 mg twice daily, 33.3% with index dose of 49/51 mg twice daily, and 11.9% with index dose at target dose of 97/103 twice daily; 20.0% of pts achieved target S/V dose of 97/103 mg twice daily. During the 3-month post-index, compared with the 3-month pre-index, there were no differences in percentages of pts with fill(s) for evidence-based BB: 78.1% vs. 80.7%, p=.070, MRA: 42.1% vs. 42.1%, p=1.000, loop diuretic: 63.0% vs. 66.0%, p=.086, or digoxin: 20.3% vs. 19.1%, p=.209; however, a lower percentage of pts filled thiazide diuretics (5.0 vs. 9.7%, p Conclusions Compared to 3 months pre-initiation, overall pt cost burden for medical care was lower in the first 3 months of S/V initiation, despite higher pt costs for outpatient pharmacy fills. Potential patient paid cost neutrality early after S/V initiation should be included in discussions, as needed, as part of shared decision making when introducing S/V therapy.