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Integrating Cost into Shared Decision-Making for Heart Failure with Reduced Ejection Fraction (POCKET-COST-HF): A Trial Providing Out-of-Pocket Costs for Heart Failure Medications during Clinical Encounters.
Montembeau, Sarah C; Rao, Birju R; Mitchell, Andrea R; Speight, Candace D; Allen, Larry A; Halpern, Scott D; Ko, Yi-An; Matlock, Daniel D; Moore, Miranda A; Morris, Alanna A; Scherer, Laura D; Ubel, Peter; Dickert, Neal W.
Afiliación
  • Montembeau SC; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA. Electronic address: Sarah.Catherine.Montembeau@emory.edu.
  • Rao BR; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
  • Mitchell AR; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
  • Speight CD; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
  • Allen LA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
  • Halpern SD; Palliative and Advanced Illness Research (PAIR) Center and Department of Medicine, Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Ko YA; Department of Biostatistics, Emory University Rollins School of Public Health, Atlanta, GA.
  • Matlock DD; Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
  • Moore MA; Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA.
  • Morris AA; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
  • Scherer LD; Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
  • Ubel P; Duke University Fuqua School of Business, Durham, NC.
  • Dickert NW; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
Am Heart J ; 269: 84-93, 2024 03.
Article en En | MEDLINE | ID: mdl-38096946
ABSTRACT

BACKGROUND:

Evidence-based medical therapy for heart failure with reduced ejection fraction (HFrEF) often entails substantial out-of-pocket costs that can vary appreciably between patients. This has raised concerns regarding financial toxicity, equity, and adherence to medical therapy. In spite of these concerns, cost discussions in the HFrEF population appear to be rare, partly because out-of-pocket costs are generally unavailable during clinical encounters. In this trial, out-of-pocket cost information is given to patients and clinicians during outpatient encounters with the aim to assess the impact of providing this information on medication discussions and decisions.

HYPOTHESIS:

Cost-informed decision-making will be facilitated by providing access to patient-specific out-of-pocket cost estimates at the time of clinical encounter.

DESIGN:

Integrating Cost into Shared Decision-Making for Heart Failure with Reduced Ejection Fraction (POCKET-COST-HF) is a multicenter trial based at Emory Healthcare and University of Colorado Health. Adapting an existing patient activation tool from the EPIC-HF trial, patients and clinicians are presented a checklist with medications approved for treatment of HFrEF with or without patient-specific out-of-pocket costs (obtained from a financial navigation firm). Clinical encounters are audio-recorded, and patients are surveyed about their experience. The trial utilizes a stepped-wedge cluster randomized design, allowing for each site to enroll control and intervention group patients while minimizing contamination of the control arm.

DISCUSSION:

This trial will elucidate the potential impact of robust cost disclosure efforts and key information regarding patient and clinician perspectives related to cost and cost communication. It also will reveal important challenges associated with providing out-of-pocket costs for medications during clinical encounters. Acquiring medication costs for this trial requires an involved process and outsourcing of work. In addition, costs may change throughout the year, raising questions regarding what specific information is most valuable. These data will represent an important step towards understanding the role of integrating cost discussions into heart failure care. GOV IDENTIFIER NCT04793880.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 1_ASSA2030 Problema de salud: 1_financiamento_saude Asunto principal: Disfunción Ventricular Izquierda / Insuficiencia Cardíaca Límite: Humans Idioma: En Revista: Am Heart J Año: 2024 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 1_ASSA2030 Problema de salud: 1_financiamento_saude Asunto principal: Disfunción Ventricular Izquierda / Insuficiencia Cardíaca Límite: Humans Idioma: En Revista: Am Heart J Año: 2024 Tipo del documento: Article
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