SPC365

Pill burden and out-of-pocket medication costs of a contemporary heart failure with reduced ejection fraction cohort

Session: CO 10 - Insuficiência cardíaca crónica
Speaker: Andreia Campinas

Congress: CPC 2021
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.7 Chronic Heart Failure - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Andreia Campinas; Sérgio Campos; Ricardo Costa; André Dias De Frias; Anaisa Pereira; Maria Trêpa; Catarina Peixoto Gomes; Mário Silva Santos; Severo Torres
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></u><span style="font-family:&quot;Times New Roman&quot;,serif">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Modern</span> <span style="font-family:&quot;Times New Roman&quot;,serif">pharmacological treatment of heart failure with reduced ejection fraction (HFrEF) dramatically improves its prognosis. However, the increasingly complexity and associated costs might threat their effective uptake in clinical practice.</span> <span style="font-family:&quot;Times New Roman&quot;,serif">We aimed to study the pill burden and out-of-pocket costs of cardiovascular drug therapy of a contemporary cohort of HFrEF patients.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></u><span style="font-family:&quot;Times New Roman&quot;,serif">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">We performed a retrospective, cross-sectional, single-center study on a convenience sample of 100 consecutive HFrEF patients assessed at our HF outpatient clinic (January-June 2020). The pill burden was assessed by the number of prescribed different cardiovascular drugs and pills per day. The out-of-pocket (OOP) costs were defined using the total patients co-payment of cardiovascular medications per month of treatment, taken in account the exemptions provided by the Portuguese National Health System (NHS). The included drug classes were antiplatelets, anticoagulants, statins, HF drugs (Beta-blockers [BB], a</span><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">ngiotensin-converting enzyme inhibitors [</span></span></span><span style="font-family:&quot;Times New Roman&quot;,serif">ACEi]/ </span><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">angiotensin receptor blockers [</span></span></span><span style="font-family:&quot;Times New Roman&quot;,serif">ARBs]/ </span><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">angiotensin receptor-neprilysin inhibition</span></span></span><span style="font-family:&quot;Times New Roman&quot;,serif"> [ARNI], </span><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">mineralocorticoid&nbsp;antagonists&nbsp;[</span></span></span><span style="font-family:&quot;Times New Roman&quot;,serif">MRA], </span><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">sodium glucose cotransport inhibitors [</span></span></span><span style="font-family:&quot;Times New Roman&quot;,serif">iSGLT2], digoxin, loop diuretic) and antiarrhythmics. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></u><span style="font-family:&quot;Times New Roman&quot;,serif">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">The mean age was 62&plusmn;12 years and only 24% were female. The etiology of HF was ischemic in 42% of the patients, 86% were in NYHA II class and 5% in NYHA III-IV. The mean LVEF was 34&plusmn;5% and the median NT-proBNP was 482 pg/mL [172-1120]. 92% of patients were on BB, 67% on ACEI/ARBs, 25% on ARNI, 81% on MRA and 30% on iSGLT2. The use of implantable cardioverter-defibrillators was 38% </span><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">an</span></span></span><span style="font-family:&quot;Times New Roman&quot;,serif">d 20% of patients were resynchronized. The number of cardiovascular (CV) drugs per day was 5.4&plusmn;1.6 per patient and the number of CV pills per day was 6.6&plusmn;2. Most patients (65%) had low income and had the maximal exemption on medication costs provided by NHS.&nbsp; Overall, the mean OOP costs was &euro;16.1 per month of treatment and the mean OOP costs for patients exempted and not exempted was &euro;12.9 and &euro;22.3, respectively. The mean OOP costs of </span><span style="font-family:&quot;Times New Roman&quot;,serif">evidence-based HF-modifying drugs</span> <span style="font-family:&quot;Times New Roman&quot;,serif">(BB, ACEI/ARBs, ARNI, MRA, iSGLT2) was &euro;10.1 and the mean OOP costs of </span><span style="font-family:&quot;Times New Roman&quot;,serif">evidence-based HF-modifying drugs for patients exempted and not exempted were &euro;7.9 and &euro;14.2, respectively. However, for patients on ARNI the mean OOP costs was almost 3 times higher (&euro;33.6).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions</span></u><span style="font-family:&quot;Times New Roman&quot;,serif">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">In this optimally treated </span><span style="font-family:&quot;Times New Roman&quot;,serif">contemporary cohort of HFrEF, the pill burden due to cardiovascular therapy only is high (7 pills/day). With the exception of patients on ARNI, the overall OOP costs of HF-modifying prognostic drugs are low. Further studies are needed to assess the impact of these variables in the adherence of HF treatment.</span></span></span></p>